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Objectives: Clinician acceptance influences technology adoption, but UK health professionals' attitudes towards artificial intelligence (AI) in hearing healthcare are unclear. This study aimed to address this knowledge gap. Methods: An online survey, based on the Checklist for Reporting Results of Internet E-Surveys, was distributed to audiologists, ENT specialists and general practitioners. The survey collected quantitative and qualitative data on demographics and attitudes to AI in hearing healthcare. Results: Ninety-three participants (mean age 39 years, 56 per cent female) from three professional groups (21 audiologists, 24 ENT specialists and 48 general practitioners) responded. They acknowledged AI's benefits, emphasised the importance of the clinician–patient relationship, and stressed the need for proper training and ethical considerations to ensure successful AI integration in hearing healthcare. Conclusion: This study provides valuable insights into UK healthcare professionals' attitudes towards AI in hearing health and highlights the need for further research to address specific concerns and uncertainties surrounding AI integration in hearing healthcare. [ABSTRACT FROM AUTHOR]

Background: The Deep End network in the North East and North Cumbria (NENC) was set up to tackle health inequalities in general practice. One aim is to address the inverse care law and improve recruitment of GPs, which is known to be especially challenging in areas of socioeconomic deprivation. Aim: To explore GP trainees’ experiences and perceptions of working in Deep End or Deprived Area Practices (DE/DAPs) to identify how GP recruitment can be improved. Design & setting: Qualitative study recruiting 13 doctors training to be GPs from the Northumbria training programme. Method: Audio-recorded, online, semi-structured interviews and discussion groups were undertaken, transcribed verbatim, and analysed with a grounded theory approach, using a process of thematic analysis. Results: Overall, seven interviews and two discussion groups (13 participants in total) were conducted. Three themes were identified. The first theme was working in areas of socioeconomic deprivation is challenging but has many advantages. The challenges of working in DE/DAPs were not deterring factors for GP trainees wanting to work in areas of socioeconomic deprivation. The second theme was trainees are willing to work in areas of socioeconomic deprivation but clinical experience is important. Training in DE/DAPs gives trainees the confidence to work in areas of deprivation. Familiarity with a practice also makes them more likely to stay post-training. The third theme was financial incentives are not an important attracting factor but support and development opportunities are. Non-pecuniary measures, such as clinical support and protected time for continuing professional development (CPD), were found to be important. Conclusion: To improve recruitment to DE/DAPs, investments should be made to increase the opportunities to train in these environments. This can be achieved by supporting more DE/DAPs to become training practices, and providing clinical support and protected time for CPD. [ABSTRACT FROM AUTHOR]

Background: Several researchers and policymakers have acknowledged the alarming association between social media (SM) usage and anxiety symptoms in young adults. While primary care holds a crucial role in the improvement ofhealth outcomes for those presenting with anxiety, there has been no research on GPs’ perceptions of the impact of SM on anxiety. Furthermore, there has been little discussion of SM as a risk factor in anxiety-related consultations. This study is the first to use empirical research to inform how primary care can adapt to address SM’s impact on anxiety within young adults. Aim: To identify the facilitators and barriers within primary care to addressing SM’s impact on anxiety among young adults. Design & setting: A qualitative study of GPs in the UK. Method: Following an exploratory pilot interview, semi-structured interviews with GPs (n = 7) were transcribedand thematically analysed, following an inductive approach. Results: The following six facilitators were identified: a framework to facilitate discussion; open GP attitudes; GP training; referral pathways; larger stakeholder influence; and young adult education of social media’s impact on anxiety. The following three barriers were identified: a lack of GP awareness of SM’s impact on anxiety; cautious GP attitudes; and increased pressure on the health service. Conclusion: This qualitative study revealed a diversity of perceptions, and these novel findings are instructive intheadaptationof primary care services to meet the current mental health needs of young adults, as well as better assisting GPs in engaging in these conversations, especially within university practice. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

With the global challenge of antimicrobial resistance (AMR), interest in the development of antibiotic alternatives has surged worldwide. While phage therapy is not a new phenomenon, technological and socio-economic factors have limited its implementation in the Western world. There is now a resurged effort, especially in the UK, to address these challenges. In this study, we collect survey data on UK general practitioners (n = 131) and other healthcare professionals (n = 103), as well as interviews with medical professionals (n = 4) and a focus group with medical students (n = 6) to explore factors associated with their willingness to prescribe phage therapy to patients. The interviews with medical professionals show support for the expansion of bacteriophage clinical trials and highlight their role as a viable alternative to antibiotics. A conjoint experiment reveals that success rate, side effect rate, and patient attitude to treatment are the decisive factors when it comes to phage therapy prescription; in contrast, the effects of administration route, type of treatment, and severity of infection were not statistically significant. Moreover, we show that general practitioners overall are more likely to recommend phage treatment to patients, compared to other healthcare professionals. The results of the study suggest that phage therapy has a potential to be widely accepted and used by healthcare workers in the UK. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosis of axial spondyloarthritis (axSpA) is frequently delayed for years after symptom onset. However, little is known about patient and healthcare professional (HCP) perspectives on barriers and facilitators in axSpA diagnosis. This study explored the experiences and perceptions of both groups regarding the factors affecting the timely diagnosis of axSpA. Method: Semi-structured interviews with patients with axSpA and axSpA-interested HCPs from the United Kingdom (UK) were performed by telephone or Microsoft Teams and focussed on the individuals' perspective of the diagnostic journey for axSpA. Interview transcripts were thematically analysed. Results: Fourteen patients with axSpA (10 female, 4 male) and 14 UK based HCPs were recruited, the latter comprising of 5 physiotherapists, 4 General Practitioners, 3 rheumatologists, a nurse, and an occupational therapist. Barriers to diagnosis identified by patients and HCPs were: difficult to diagnose, a lack of awareness, unclear referral pathways, patient behaviour and patient/HCP communication. Patient-identified facilitators of diagnosis were patient advocacy, clear referral processes and pathways, increased awareness, and serendipity. HCPs identified promoting awareness as a facilitator of diagnosis, along with symptom recognition, improvements to healthcare practice and patient/HCP communications. Conclusion: Poor communication and a lack of understanding of axSpA in the professional and public spheres undermine progress towards timely diagnosis of axSpA. Improving communication and awareness for patients and HCPs, along with systemic changes in healthcare (such as improved referral pathways) could reduce diagnostic delay. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) results in extensive physical, psychological, and social benefits. Despite primary care being a key point of influence for PA behaviours in the UK, research indicates poor application of PA interventions in this context. To address this, the Royal College of General Practitioners' (RCGP) developed and implemented the Active Practice Charter (APC). The aim of the study was to evaluate the perceived impact and acceptability of the APC initiative from the perspective of primary healthcare professionals (PHPs). Methods: An online exploratory cross-sectional survey was designed to assess the perceived impact, experiences, and challenges of the APC initiative, from the perspective of PHPs. The survey was distributed by the RCGP via email to 184 registered APC practices across the UK. Results: Responses were reviewed from staff (n = 33) from 21 APC practices. Initiatives used by APC practices included: educational programmes, partnerships with PA providers, referral systems, and infrastructure investment. Perceived benefits included: increased awareness about PA, staff cohesion, and improved well-being. However, staff felt the APC had limited effect due to implementation barriers, including: a lack of engagement, time, resources, and funding. Conclusion: This is the first evaluation of any nationwide UK-based initiative engaging GP practices in promoting PA. Acknowledging the limitations in response rate, although support exists for the RCGP APC, the evaluation highlights challenges to its implementation. Nonetheless, the wide reach of the RCGP, combined with the cited staff and patient benefits, demonstrates the significant potential of the APC initiative. Given the need to address physical inactivity nationally, further development the APC offers a possible solution, with further research required to overcome the challenges to implementation. [ABSTRACT FROM AUTHOR]

Objective: Depression is an increasingly common mental health disorder in the UK, managed predominantly in the community by GPs. Emerging evidence suggests lifestyle medicine is a key component in the management of depression. We aimed to explore GPs' experiences, attitudes, and challenges to providing lifestyle advice to patients with depression. Method: Focus groups were conducted virtually with UK GPs (May-July 2022). A topic guide facilitated the discussion and included questions on experiences, current practices, competence, challenges, and service provision. Data were analysed using template analysis. Results: 'Supporting Effective Conversations'; 'Willing, but Blocked from Establishing Relational Care'; 'Working Towards Patient Empowerment'; and 'Control Over the Prognosis' were all elements of how individualised lifestyle advice was key to the management of depression. Establishing a doctor-patient relationship by building trust and rapport was fundamental to having effective conversations about lifestyle behaviours. Empowering patients to make positive lifestyle changes required tailoring advice using a patient-centred approach. Confidence varied across participants, depending on education, experience, type of patient, and severity of depression. Conclusions: GPs play an important role in managing depression using lifestyle medicine and a patient-centred approach. Organisational and educational changes are necessary to facilitate GPs in providing optimal care to patients with depression. [ABSTRACT FROM AUTHOR]

Background: Threats such as African swine fever (ASF) are in close proximity to the UK; therefore, it is a crucial time to protect the British pig herd from exotic notifiable disease, which can be best achieved through legislative adherence. This is especially the case for laws around the feeding of pigs, which remains the likely route for ASF to enter the UK. Keepers of pigs on a small scale, including keepers of pet pigs, may show variable adherence to the relevant legislation. Furthermore, general farm practitioners, often responsible for supervising small‐scale pig holdings, may be less familiar with legislative requirements than those vets who deal solely with pigs. Despite this, legal requirements must be met on all holdings and overseeing vets are key to encouraging legislative compliance among keepers. Aim of the article: This article, the first in a two‐part series on working with small‐scale pig keepers, serves as a reference for vets so that they can provide their clients with up‐to‐date advice on how to keep pigs within the legal framework for the UK. It also offers advice on how this information could be shared among pig keepers. Part two, which will be published in a subsequent issue of In Practice, will focus on how we, as vets, can encourage antibiotic stewardship on smallholdings. [ABSTRACT FROM AUTHOR]

Background: There are various Medical Subject Headings (MeSH) terms used to index general practice research, without consistency. Aim: To understand how general practice-related research is indexed in the main general practice journals between 2011 and 2021, and to analyse the factors that influenced the choice of the general practice-related MeSH. Design and setting: This was a quantitative bibliometric study conducted on MEDLINE. Method: MeSH were selected according to the international definition of General Practice/Family Medicine: 'General Practice', 'Primary Health Care', 'Family Practice', 'General Practitioners', 'Physicians, Primary Care', and 'Physicians, Family'. Their use was studied from 2011 to 2021 on MEDLINE, reviewing the 20 general practice journals with the highest impact factors. A descriptive and analytical approach was used; the association of the country, journal, and year with the choice of general practice-related MeSH terms was analysed. Results: A total of 8514 of 150 286 articles (5.7%) were using one of the general practice-related MeSH terms. The most used were 'Primary Health Care' (4648/9984, 46.6%) and 'General Practice' (2841/9984, 28.5%). A total of 80.0% (6172/7723) of the articles were related to the UK or US and 71.0% (6055/8514) of the articles came from four journals (BJGP, BMJ, Journal of General Internal Medicine, and Annals of Family Medicine). Two main country clusters emerged from the use of general practice-related MeSH: a British cluster mainly using 'General Practice' and an American cluster using 'Primary Health Care'. The journals also mainly differed in their used of these two MeSH terms. Conclusion: Important variations in the indexation of general practice research were found. Researchers should consider combining 'Primary Health Care' and 'General Practice' in their PubMed searches to access all the general practice research, regardless of their country of origin. [ABSTRACT FROM AUTHOR]

Public transport accessibility to urban and regional services has been found to relate to various social and economic processes, such as unemployment, transport mode choice, property prices, and public health. A frequent type of measures representing accessibility are location-based. While these offer advantages, like flexibility and ease of interpretation, their estimation usually requires specialized skills and substantial computational resources. To lower these barriers, we have prepared a suite of accessibility indicators for key services across Great Britain at a spatially disaggregated level. The dataset includes ready-to-use public transport accessibility indicators for employment, general practitioners (GP, or family physician), hospitals, grocery stores, supermarkets, primary and secondary schools, and urban centres. It also includes the raw travel time matrix from each origin to every potential destination, a primary input for such indicator estimation. Altogether, this resource offers various levels of application, from direct input into a range of research topics to the foundation for creating comprehensive custom indicators. [ABSTRACT FROM AUTHOR]

To investigate veterinarians' experience and perception of the risk of veterinary prescription medication (VPM) misuse and abuse by the public and veterinary professionals and to determine the clinical context in which respondent veterinarians prescribed certain VPMs. Anonymous online voluntary survey. A total of 361 of 7126 veterinarians registered as practicing in the UK, who provided e-mail contact details to the Royal College of Veterinary Surgeons Knowledge for participation in research. Respondents included general practitioners, with or without further qualifications, and European specialists, covering charity, private or academic small, large or mixed animal practice. The anonymous online survey, open from September to December 2021, posed 27 questions regarding personal experience and perception of VPM misuse or abuse, including which VPMs were considered most at risk of abuse by clients or veterinary staff. Thematic analysis was performed on free-text sections. The participation rate was 5% (361/7126), and the completion rate 60% (216/361 respondents). Of these, 88% of respondents somewhat agreed, agreed or strongly agreed that some VPMs were at risk of abuse. A third (29.9%; 107/358) had suspected an owner of taking VPMs, and one fifth (20.1%; 72/358) had suspected veterinary staff. Perceptions regarding the likelihood of public VPM abuse ranged from not suspecting a problem to having first-hand experience. Drugs considered most at risk of owner abuse were opioids, benzodiazepines and gabapentin, and those for veterinary staff were opioids, benzodiazepines and ketamine. Numerous 'red flags' prompting suspicion of VPM abuse were identified alongside ways of mitigating risk. Veterinarians in the UK reported varied experiences with, awareness of, and attitudes towards VPM abuse by the public and veterinary staff. Although not quantified, the UK veterinary industry could be a source of abusable drugs. [ABSTRACT FROM AUTHOR]

Background: It is difficult to engage busy healthcare professionals in research. Yet during the COVID-19 pandemic, gaining their perspectives has never been more important. Objective: To explore social media data for insights into the wellbeing of UK General Practitioners (GPs) during the Covid-19 pandemic. Methods: We used a combination of search approaches to identify 381 practising UK NHS GPs on Twitter. Using a two stage social media analysis, we firstly searched for key themes from 91,034 retrieved tweets (before and during the pandemic). Following this we used qualitative content analysis to provide in-depth insights from 7145 tweets related to wellbeing. Results: Social media proved a useful tool to identify a cohort of UK GPs; following their tweets longitudinally to explore key themes and trends in issues related to GP wellbeing during the pandemic. These predominately related to support, resources and public perceptions and fluctuations were identified at key timepoints during the pandemic, all achieved without burdening busy GPs. Conclusion: Social media data can be searched to identify a cohort of GPs to explore their wellbeing and changes over time. [ABSTRACT FROM AUTHOR]

Background: The incidence of early-onset colorectal cancer (EOCRC) in adults aged <50 years has increased in several Western nations. National surveys have highlighted significant barriers to accessing timely care for patients with EOCRC, which may be contributing to a late stage of presentation in this population group. Aim: To explore awareness of the increasing incidence of EOCRC, and to understand the potential barriers or facilitators faced by GPs when referring younger adults to secondary care with features indicative of EOCRC. Design & setting: Qualitative methodology, via virtual semi-structured interviews with 17 GPs in Northern Ireland. Method: Reflective thematic analysis was conducted with reference to Braun and Clarke's framework. Results: Three main themes were identified among participating GPs: awareness, diagnostic, and referral challenges. Awareness challenges focused on perceptions of EOCRC being solely associated with hereditary cancer syndromes, and colorectal cancer being a condition of older adults. Key diagnostic challenges centred around the commonality of lower gastrointestinal complaints and overlap in EOCRC symptoms with benign conditions. Restrictions in age-based referral guidance and a GP 'guilt complex' surrounding over-referral to secondary care summarised the referral challenges. Young females were perceived as being particularly disadvantaged with regard to delays in diagnosis. Conclusion: This novel research outlines potential reasons for the diagnostic delays seen in patients with EOCRC from a GP perspective, and highlights many of the complicating factors that contribute to the diagnostic process. [ABSTRACT FROM AUTHOR]

Background: Patients with unmet healthcare needs are more likely to access unscheduled care. Identifying these patients through data-driven and clinical risk stratification for active case management in primary care can help address patient need and reduce demand on acute services. Aim: To determine how a proactive digital healthcare system can be used to undertake comprehensive needs analysis of patients at risk of unplanned admission and mortality. Design & setting: Prospective cohort study of six general practices in a deprived UK city. Method: To identify those with unmet needs, the study's population underwent digitally-driven risk stratification into Escalated and Non-escalated groups using seven risk factors. The Escalated group underwent further stratification using GP clinical assessment into Concern and No concern groups. The Concern group underwent Unmet Needs Analysis (UNA). Results: From 24 746 patients, 516 (2.1%) were triaged into the Concern group and 164 (0.7%) underwent UNA. These patients were more likely to be older (t = 4.69, P<0.001), female (X2 = 4.46, P<0.05), have a Patients At Risk of Re-hospitalisation (PARR) score ≥80 (X2 = 4.31, P<0.05), be a nursing home resident (X2 = 6.75, P<0.01), or on an end-of-life (EOL) register (X2 = 14.55, P<0.001). Following UNA, 143 (87.2%) patients had further review planned or were referred for further input. The majority of patients had four domains of need. In those who GPs would not be surprised if they died within the next few months, n = 69 (42.1%) were not on an EOL register. Conclusion: This study showed how an integrated, patient-centred, digital care system working with GPs can highlight and implement resources to address the escalating care needs of complex individuals. [ABSTRACT FROM AUTHOR]

Background: Family history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention, and Early Detection (SPED). Family History Questionnaire Service (FHQS) is a resource-efficient patient-facing online tool to facilitate this. In the UK, cancer risk assessment is usually only offered to concerned individuals proactively self-presenting to their GP, leading to inequity in accessing SPED in the community. Aim: To improve access to community cancer genetic risk assessment and explore barriers to uptake. Design & setting: Service development project of a digital pathway using the FHQS for cancer risk assessment across four general practices within the clinical remit of the South West Thames Centre for Genomics (SWTCG). Method: 3100 individuals aged 38-50 years were invited to complete the FHQS through either text message or email. A random selection of 100 non-responders were contacted to determine barriers to uptake. Results: In total, n = 304/3100 (10%) registered for the FHQS. Responders were more likely to be British (63% vs 47%, P<0.001), speak English as their main language (92% vs 76%, P<0.001), and not require an interpreter (99.6% vs 94.9%, P = 0.001). Of 304 responders, 158 (52%) were automatically identified as at population-risk without full family history review. Of the remaining 146 responders, 52 (36%) required either additional screening referral (n = 23), genetics referral (n = 15), and/or advice to relatives (n = 18). Of 100 non-responders contacted, eight had incorrect contact details and 53 were contactable. Reasons for not responding included not receiving invitation details (n = 26), losing the invitation (n = 5), or forgetting (n = 4). Conclusion: The FHQS can be used as part of a low-resource primary care pathway to identify individuals in the community above population-risk for cancer requiring action. This study highlighted barriers to uptake requiring consideration to maximise impact and minimise inequity. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems are under unprecedented pressure. GPs are crucial to the health of the population, yet their own health and wellbeing is often overlooked. Aim: To investigate feelings of burnout, psychological wellbeing, and musculoskeletal complaints in GPs across the UK and to examine whether these health outcomes vary according to the time GPs spent sitting, their participation in physical activity each day, and the time spent working per day or week. Design & setting: Observational study involving GPs located across the UK. Method: An online survey was emailed to working members of the Royal College of General Practitioners and shared on social media between October and December 2020. The survey included questions on burnout, psychological wellbeing, musculoskeletal complaints, sitting time, physical activity, and time spent working. Mean differences were examined for burnout, psychological wellbeing, and musculoskeletal complaints. Results: Data from 406 GPs showed a high level of burnout (35.5%) and musculoskeletal complaints (neck, shoulder and back: 81.8%; arms: 28.3%; and legs: 49.8%). Psychological wellbeing was low in 22.9% of GPs. Burnout was lower in GPs who met current physical activity guidelines, while psychological wellbeing was higher in those with >2 breaks in sitting per hour. Musculoskeletal complaints were higher in those spending >50% of sitting time in prolonged bouts (≥30 minutes). Conclusion: A high proportion of GPs reported experiencing burnout and musculoskeletal complaints, but these health concerns were less evident in GPs who spent less time in prolonged sitting, took more breaks in sitting, and who were more physically active. [ABSTRACT FROM AUTHOR]

Background: Information on the hours of work of UK doctors is limited, and what exists relies on self-designed questionnaires in England. Aim: To understand trends in the annual stock of physicians' hours and their main determinants. Design & setting: A quantitative study in which data were collected from the Quarterly Labour Force Survey (QLFS) between 1998 and 2020, under the End User Licence (EUL), in the UK. Method: Descriptive and linear regression models of labour supply for doctors (pooled), GPs, and hospital doctors. Results: Between 1998 and 2020, while the headcount of doctors grew by 128.79% for hospital doctors and 45.28% for GPs, hours of work dropped by 20.80% for hospital doctors and 25.37% for GPs. Hence, the annual stock of hours grew by 81.20% for hospital doctors but by a modest 8.42% for GPs. Female doctors worked 8.68 fewer hours than males, with GPs reporting the largest reduction (-11.82 hours, 95% confidence interval [CI] = -13.31 to -10.33 and -6.75, 95% CI = -9.32 to -4.19, in the full specification). Family decisions are associated with a fall in doctors' work hours and modest growth in the annual stock of hours. These determinants and overtime are drivers of part-time work. Conclusion: Despite the increase in the headcount of GPs, their hours of work dropped over the study period, generating a more steady and modest growth in their total annual stock of hours compared with hospital doctors. Female GPs work fewer hours than male GPs and are more likely to work part-time due to childbearing, marriage/co-habitation, and overtime work. [ABSTRACT FROM AUTHOR]

Background: The number of children exposed to maternal mental illness is rapidly increasing and little is known about the effects of maternal mental illness on childhood atopy. Aim: To investigate the association between maternal mental illness and risk of atopy among offspring. Design and setting: Retrospective cohort study using a UK primary care database (674 general practices). Method: In total, 590 778 children (born 1 January 1993 to 30 November 2017) were followed until their 18th birthday, with 359 611 linked to their hospital records. Time-varying exposure was captured for common (depression and anxiety), serious (psychosis), addiction (alcohol and substance misuse), and other (eating and personality disorder) maternal mental illness from 6 months before pregnancy. Using Cox regression models, incidence rates of atopy were calculated and compared for the exposed and unexposed children in primary (asthma, eczema, allergic rhinitis, and food allergies) and secondary (asthma and food allergies) care, adjusted for maternal (age, atopy history, smoking, and antibiotic use), child (sex, ethnicity, and birth year/season), and area covariates (deprivation and region). Results: Children exposed to common maternal mental illness were at highest risk of developing asthma (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] = 1.15 to 1.20) and allergic rhinitis (aHR 1.17, 95% CI = 1.13 to 1.21), as well as a hospital admission for asthma (aHR 1.29, 95% CI = 1.20 to 1.38). Children exposed to addiction disorders were 9% less likely to develop eczema (aHR 0.91, 95% CI = 0.85 to 0.97) and 35% less likely to develop food allergies (aHR 0.65, 95% CI = 0.45 to 0.93). Conclusion: The finding that risk of atopy varies by type of maternal mental illness prompts important aetiological questions. The link between common mental illness and childhood atopy requires GPs and policymakers to act and support vulnerable women to access preventive (for example, smoking cessation) services earlier. [ABSTRACT FROM AUTHOR]

Background: The United Kingdom health system is challenged with retaining doctors entering specialty training directly after their second foundation year. Improving doctors' training experience during the foundation programme may aid such retention. The Longitudinal Integrated Foundation Training (LIFT) pilot scheme aimed to provide a programme that improves the quality of their foundation training experience, advance patient-centred care and provide doctors with more experience in the primary care settings. Methods: During this pilot study, three methods were employed to evaluate and compare doctors' experiences across their 2-year foundation training programme: Horus ePortfolio assessment of six domains for good medical practice analysed using a T-test, online survey assessments analysed using a 2-tailed chi-square test, and focus group feedback sessions with thematic analysis. Results: Doctors completing LIFT (n = 47) scored a higher but non-significant mean score on all six domains for good medical practice versus doctors completing traditional foundation training (n = 94). By the end of foundation training, 100% of LIFT doctors rated their understanding of how primary and secondary care work together as high versus 78.7% of traditional doctors (p < 0.05). Improvements in wellbeing were observed among LIFT doctors, along with a reduction in the proportion of doctors considering leaving medical training. A significantly greater number of LIFT doctors versus traditional doctors rated their compassion for patients as high (100% versus 86.8%; p < 0.05), intended to become general practitioners (23.1% versus 13.5%; p < 0.05) and rated the extent to which they felt well informed and able to consider a general practice career rather than a hospital career as high (91.7% versus 72.3%, respectively; p < 0.05). Some LIFT doctors felt they had reduced exposure to secondary care, received less on-call experience and considered working a half-day to be problematic; challenges ameliorated by the end of the 2-year foundation programme. Conclusion: The LIFT programme enhanced the quality of foundation training and improved doctors' experiences and competencies, generating valuable insights for the future of education and healthcare delivery. Applying the principles of LIFT to foundation training helps doctors to be more compassionate and patient-centred, leading to enhanced individualised patient care. [ABSTRACT FROM AUTHOR]

Falls represent a huge health and economic burden. Whilst many factors are associated with fall risk (e.g. obesity and physical inactivity) there is limited evidence for the causal role of these risk factors. Here, we used hospital and general practitioner records in UK Biobank, deriving a balance specific fall phenotype in 20,789 cases and 180,658 controls, performed a Genome Wide Association Study (GWAS) and used Mendelian Randomisation (MR) to test causal pathways. GWAS indicated a small but significant SNP-based heritability (4.4%), identifying one variant (rs429358) in APOE at genome-wide significance (P < 5e-8). MR provided evidence for a causal role of higher BMI on higher fall risk even in the absence of adverse metabolic consequences. Depression and neuroticism predicted higher risk of falling, whilst higher hand grip strength and physical activity were protective. Our findings suggest promoting lower BMI, higher physical activity as well as psychological health is likely to reduce falls. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) – an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring—may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future. Methods: This exploratory qualitative study used semi-structured interviews to explore participants' experiences of clinical services across the UK during the pandemic. All data were collected remotely (March – May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis. Results: Of the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future. Conclusions: Our findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it's future services, the mode of appointment—remote (telephone, video call), or in-person – needs to be flexible and suit the patient. [ABSTRACT FROM AUTHOR]

Aims: Early intervention in people with an at‐risk mental state (ARMS) for psychosis can prevent the onset of psychosis. Clinical guidelines recommend that ARMS are referred to triage services, and then to Early Intervention (EI) teams in secondary care for assessment and treatment. However, little is known about how ARMS patients are identified and managed in UK primary and secondary care. This study explored patients' and clinicians' views of ARMS patients' care pathways. Methods: Eleven patients, 20 GPs, 11 clinicians from the triaging Primary Care Liaison Services (PCLS) and 10 EI clinicians were interviewed. Data were analysed thematically. Results: Most patients said their symptoms started in adolescence with depression and anxiety. Before being referred to EI teams, most patients were referred by their GP to well‐being services for talking therapies, which they had not found helpful. Some GPs said secondary care's high acceptance thresholds and scarce treatment availability made them reluctant to refer to EI teams. Triage in PCLS was influenced by patients' risk of self‐harm, and formulation of psychotic symptoms; only those without clear evidence of other pathology and not at high risk of self‐harm were referred to EI teams, the others being referred to Recovery/Crisis services. Although patients referred to EI teams were offered an assessment, only some EI teams were commissioned to treat ARMS. Conclusions: Individuals meeting ARMS criteria might not receive early intervention due to high treatment thresholds and limited treatment availability in secondary care, suggesting clinical guidelines are not being met for this patient group. [ABSTRACT FROM AUTHOR]

Keeping professionally up to date in 18th‐century Britain was not an easy undertaking. Learning on the job was insufficient for the further development of individual medical knowledge. The century witnessed the gradual growth of medical societies to provide a better education than that offered by university institutions. The Worshipful Society of Apothecaries of London in 1815 was empowered to licence and regulate medical practitioners, today's general practitioners. Societies were established in Edinburgh but not so many as around London, where a particularly successful education body was established in 1773, the prestigious Medical Society of London. In 1805 a breakaway group from the society formed an equally highly respected learned body, the Medical and Chirurgical Society of London, that became the nidus for the amalgamation of numerous specialist societies to form, in June 1907, the extant Royal Society of Medicine. By the end of the 18th century, the medical society had fostered professionalism, education and unification within diverse medical and scientific disciplines. [ABSTRACT FROM AUTHOR]

DearEditor, Bullous pemphigoid (BP), mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV) are autoimmune blistering diseases that present with mucocutaneous blistering and erosions. 10 What is the best way to treat skin wounds in BP, MMP and/or PV, including how should blisters or erosions be best washed and managed and does treatment vary according to body site?. [Extracted from the article]

Background Guidelines recommend general practitioners (GPs) take every opportunity to talk to people living with obesity about their weight, and evidence shows even very brief advice is associated with weight loss. However, little is known about what GPs say when giving brief behavioural advice, and if it reflects evidence-based recommendations for people living with obesity. To understand what behavioural advice GPs give, we categorized the content and delivery of GPs' advice during brief interventions. Methods Qualitative content analysis was applied to 159 audio recordings of consultations from the Brief Interventions for Weight Loss (BWeL) trial, where GPs gave brief weight-loss advice to patients with a body mass index ≥30 kg/m2 (or ≥25 kg/m2 if Asian) in 137 UK surgeries. Similar content was grouped into descriptive clusters. Results The results comprised 4 clusters, illuminating different aspects of the advice given: (i) Content of diet and physical activity advice, showing this was highly varied; (ii) Content of "implementation tips" given to support changes, e.g. using smaller plates; (iii) Content of signposting support, either towards further clinician support, or other resources, e.g. information booklets; (iv) Style of advice delivery, showing GPs rarely gave personalized advice, or reasons for their advice. Conclusions and implications Weight-loss advice from GPs to patients with obesity rarely included effective methods, mostly communicating a general "eat less, do more" approach. Advice was mostly generic, and rarely tailored to patients' existing knowledge and behaviours. Effectiveness of brief weight-loss advice could be improved if GPs were given clearer guidance on evidence-based recommendations. [ABSTRACT FROM AUTHOR]

Purpose: In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False‐positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration. Recent findings: Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age‐related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first‐visit discharge rate was high (16.7%–48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false‐positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001). Summary: There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face‐to‐face appointments and promote communication between primary and secondary care. [ABSTRACT FROM AUTHOR]

After 75 years of reformed practice, general practitioners (GPs) in the UK have transformed from health gatekeepers who simply provide medical decision-making such as diagnostic and treatment services and referral services, to health agents who proactively provide more relevant health services such as immunizations, health monitoring and health management, etc. In order to discuss this transformation of the role of the general practitioner and the conditions for the evolution of the role, this study chose the documentary analysis method to provide a comprehensive overview of the legal and normative documents related to the general practitioner. Furthermore, this study uses a comparative analysis method to conclude the definition and role characteristics of GPs as health agents. This study summarises the general pattern of evolution of GPs into health agents. The transformation into a health agent relies on the interpersonal trust and rigorous institutional of society on the general practitioner system. The expansion of GPs' clientele and range of services, together with the motivation to proactively provide services, have combined to push for a "qualitative change" in the GP's role as health agent. The transformation of the role of the general practitioner to a health agent is a historical necessity. It responds to the evolution of society's understanding of health and the need for higher levels of health. Therefore, recognizing the role of GPs as health agents is important for optimizing the use of health care resources and improving the health of society by taking advantage of this role. [ABSTRACT FROM AUTHOR]

Background: In the UK, bariatric surgical patients are followed up for 2 years post‐operatively in hospital settings, before being discharged into General Practice for long‐term follow‐up. Presently, there is ambiguous guidance as to what should be included in a community‐based bariatric surgical follow‐up service. The aim of the study was to understand, from both patient and professional perspectives, what is needed to support the long‐term management of bariatric surgical patients in community‐based settings. Methods: Post‐surgical bariatric patients and General Practice staff were recruited from an area in the UK which has an National Health Service (NHS) hospital providing a high‐volume and established bariatric surgical service. Data was collected through semi‐structured interviews. A thematic analytic framework was used to construct eight themes which illuminated the participants' experiences. The study took place between March and December 2021. Findings: Thirty participants (14 patients and 16 healthcare professionals) were recruited to the study. The study revealed the lack of a framework for delivery of a long‐term follow up service was frustrating to both patients and professionals. Patient participants reported needing more support, especially dietetic and psychological input, and professionals stated they had little knowledge about bariatric surgical care, and what was needed to provide optimal care, but wanted to provide quality patient care. Conclusion: Long‐term follow up of bariatric surgical patients is an important issue which needs addressing. This study illuminates both the patient and professional perspectives on developing a pragmatic, community‐based service which meets the needs of patients and considers the need to incorporate such a service into existing infrastructures without adding additional demands on General Practice. [ABSTRACT FROM AUTHOR]

Background: The burden of osteoarthritis (OA) in UK primary care has not been investigated thoroughly. Aim: To estimate healthcare use and mortality in people with OA (overall and joint specific). Design and setting: A matched cohort study of adults with an incident diagnosis of OA in primary care were selected for the study using UK national Clinical Practice Research Datalink (CPRD) electronic records. Method: Healthcare utilisation was measured as the annual average number of primary care consultations and admissions to hospital after the index date for any cause and all-cause mortality data in 221 807 people with OA and an equal number of controls (with no OA diagnosis) who were matched to the case patients by age (standard deviation 2 years), sex, practice, and year of registration. The associations between OA and healthcare utilisation and all-cause mortality were estimated using multinomial logistic regression and Cox regression, respectively, adjusting for covariates. Results: The mean age of the study population was 61 years and 58% were female. In the OA group, the median number of primary care consultations per year after the index date was 10.91 compared with 9.43 in the non-OA control group (P = 0.001) OA was associated with an increased risk of GP consultation and admission to hospital. The adjusted hazard ratio for all-cause mortality was 1.89 (95% confidence interval [CI] = 1.85 to 1.93) for any OA, 2.09 (95% CI = 2.01 to 2.19) for knee OA, 2.08 (95% CI = 1.95 to 2.21) for hip OA, and 1.80 (95% CI = 1.58 to 2.06) for wrist/hand OA, compared with the respective non-OA control group. Conclusion: People with OA had increased rates of GP consultations, admissions to hospital, and all-cause mortality that varied across joint sites. [ABSTRACT FROM AUTHOR]

Background: Identifying and responding to patients affected by domestic violence and abuse (DVA) is vital in primary care. There may have been a rise in the reporting of DVA cases during the COVID-19 pandemic and associated lockdown measures. Concurrently general practice adopted remote working that extended to training and education. IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA. IRIS transitioned to remote delivery during the pandemic. Aim: To understand the adaptations and impact of remote DVA training in IRIS-trained general practices by exploring perspectives of those delivering and receiving training. Design and setting: Qualitative interviews and observation of remote training of general practice teams in England were undertaken. Method: Semi-structured interviews were conducted with 21 participants (three practice managers, three reception and administrative staff, eight general practice clinicians, and seven specialist DVA staff), alongside observation of eight remote training sessions. Analysis was conducted using a framework approach. Results: Remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training and may challenge safeguarding of remote learners who are domestic abuse survivors. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership. Conclusion: The authors recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care. [ABSTRACT FROM AUTHOR]

Background: The physician–patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions. Methods: A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1—research questions specified; Stage 2—relevant studies identified by searching five electronic databases and manual screening of references; Stage 3—studies screened using Covidence™; Stage 4—study data extracted and charted; and Stage 5—findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion. Results: In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance. Conclusion: This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients. [ABSTRACT FROM AUTHOR]

Background: Desmoid‐type fibromatosis (DTF) has a highly variable clinical course with varying intensity of symptoms. The objectives of this study were to identify subgroups of DTF patients based on physical symptom burden and to compare symptom burden subgroups on health‐related quality of life (HRQoL) and healthcare use (univariate and multivariate). Methods: Desmoid‐type fibromatosis patients from the United Kingdom and the Netherlands received cross‐sectional questionnaires on HRQoL (EORTC QLQ‐C30), DTF‐specific HRQoL (DTF‐QoL) and healthcare utilisation. Latent class cluster analysis was performed to identify subgroups based on patients' symptom burden using EORTC QLQ‐C30 and DTF‐QoL physical symptom items. Multivariate linear and logistic regression analyses were conducted to examine associations of symptom burden with HRQoL and healthcare utilisation, respectively. Results: Among 235 DTF patients, four symptom burden clusters were identified, with low symptom burden (24%), intermediate symptom burden‐low pain (20%), intermediate symptom burden‐high pain (25%) and high symptom burden (31%). DTF patients with high symptom burden had clinically relevant lower HRQoL scores compared to patients with low and intermediate symptom burden (p < 0.001) and reported more general and DTF‐related visits to their general practitioner compared to the low symptom burden cluster (p < 0.01). In the multivariate analyses, symptom burden was independently associated with both HRQoL and healthcare utilisation. Conclusions: This study identified four distinct subgroups of DTF patients based on their level of symptom burden, with a considerable number of patients being highly symptomatic. Knowledge of the level of symptom burden DTF patients experience can help to identify patients at risk of poorer outcomes and tailor supportive care to the individual needs of DTF patients. [ABSTRACT FROM AUTHOR]

Background: GPs in the UK will face increased palliative care demands in the coming years. Understanding what makes providing palliative care difficult for GPs is an important step to planning future services, but currently there is an absence of synthesised literature addressing this area. Aim: To identify the range of issues that affect GPs' provision of palliative care. Design & setting: A qualitative systematic review and thematic synthesis of studies exploring GPs' experiences of providing palliative care in the UK. Method: Four databases (MEDLINE, Embase, Web of Science, and CINAHL [Cumulated Index to Nursing and Allied Health Literature]) were searched on 1 June 2022 to identify relevant primary qualitative literature published between 2008 and 2022. Results: Twelve articles were included in the review. The following four themes were identified that affect GPs' experiences of providing palliative care: lack of resources to support palliative care provision; fragmented multidisciplinary team (MDT) approach; challenging communication with patients and carers; and inadequate training to address the complexities of palliative care. Pressures caused by increasing workloads and a lack of staffing combined with difficulty accessing specialist teams impeded GPs' provision of palliative care. Further challenges were deficiencies in GP training, and a lack of patient understanding or unwillingness to engage in palliative care discussions. Conclusion: A multifaceted approach focusing on increased resources, improved training, and a seamless interface between services, including improved access to specialist palliative teams when necessary, is needed to address the difficulties that GPs face in palliative care. Regular in-house MDT discussion of palliative cases and exploration of community resources could generate a supportive environment for GPs. [ABSTRACT FROM AUTHOR]

Background: Practice-based pharmacists (PBPs) have been introduced into general practice across the UK to relieve some of the pressures within primary care. However, there is little existing UK literature that has explored healthcare professionals' (HCPs') views about PBP integration and how this role has evolved. Aim: To explore the views and experiences of GPs, PBPs, and community pharmacists (CPs) about PBPs' integration into general practice and their impact on primary healthcare delivery. Design and setting: A qualitative interview study in primary care in Northern Ireland. Method: Purposive and snowball sampling were used to recruit triads (a GP, a PBP, and a CP) from across five administrative healthcare areas in Northern Ireland. Sampling of practices to recruit GPs and PBPs commenced in August 2020. These HCPs identified the CPs who had most contact with the general practices in which the recruited GPs and PBPs were working. Semi-structured interviews were recorded, transcribed verbatim, and analysed using thematic analysis. Results: Eleven triads were recruited from across the five administrative areas. Four main themes in relation to PBPs' integration into general practices were revealed: evolution of the role; PBP attributes; collaboration and communication; and impact on care. Areas for development were identified such as patient awareness of the PBP role. Many saw PBPs as a 'central hub–middleman' between general practice and community pharmacies. Conclusion: Participants reported that PBPs had integrated well and perceived a positive impact on primary healthcare delivery. Further work is needed to increase patient awareness of the PBP role. [ABSTRACT FROM AUTHOR]

Background: Widening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. 'Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.' This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities. Methods: Data from 2007–13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school. Results: Four thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%). Conclusions: Gateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this. [ABSTRACT FROM AUTHOR]

Introduction: Pertussis, a highly infectious respiratory disease caused by Bordetella pertussis, affects people of all ages. Older adults are particularly susceptible to its severe outcomes and complications. Methods: In this retrospective cohort study, the incidence rate of pertussis among individuals aged ≥ 50 years was assessed during 2009–2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases, United Kingdom. Health care resource utilisation (HCRU) and direct medical costs (DMCs) were compared between patients with a pertussis diagnosis and propensity score-matched controls (matched on demographic and clinical variables). Results: Among 5,222,860 individuals, 1638 had a pertussis diagnosis (incidence rate: 5.8 per 100,000 person-years; 95% confidence interval 5.5–6.0). Baseline (– 18 to – 6 months) HCRU and DMC were similar among 1480 pertussis patients and 1480 matched controls. However, there were increases in HCRU in the pertussis vs. matched cohort around the pertussis diagnosis (from months – 6 to – 1 to 5–11). The most notable increases (pertussis vs. controls) were in the rates of general practitioner (GP)/nurse visits (4.7-fold), clinical assessments (4.1-fold), and accident and emergency visits (3.0-fold) during the month before diagnosis and GP/nurse visits during the 2 months after diagnosis (2.5-fold) (all p < 0.001). DMCs were significantly higher in the pertussis cohort (p < 0.001). Total excess DMC in the pertussis cohort during months – 1 to + 11 was £318 per patient. Conclusion: A pertussis diagnosis among adults aged ≥ 50 years resulted in significant increases in HCRU and DMC across several months around diagnosis. These results highlight the need for increased awareness of pertussis infection among adults aged ≥ 50 years and suggest that pertussis booster doses among this population should be considered. [ABSTRACT FROM AUTHOR]

Introduction: Electronic medical records (EMRs) maintained in primary care in the UK and collected and stored in EMR databases offer a world-leading resource for observational clinical research. We aimed to profile one such database: the Optimum Patient Care Research Database (OPCRD).Methods and Participants: The OPCRD, incepted in 2010, is a growing primary care EMR database collecting data from 992 general practices within the UK. It covers over 16.6 million patients across all four countries within the UK, and is broadly representative of the UK population in terms of age, sex, ethnicity and socio-economic status. Patients have a mean duration of 11.7 years' follow-up (SD 17.50), with a majority having key summary data from birth to last data entry. Data for the OPCRD are collected incrementally monthly and extracted from all of the major clinical software systems used within the UK and across all four coding systems (Read version 2, Read CTV3, SNOMED DM+D and SNOMED CT codes). Via quality-improvement programmes provided to GP surgeries, the OPCRD also includes patient-reported outcomes from a range of disease-specific validated questionnaires, with over 66,000 patient responses on asthma, COPD, and COVID-19. Further, bespoke data collection is possible by working with GPs to collect new research via patient-reported questionnaires.Findings to Date: The OPCRD has contributed to over 96 peer-reviewed research publications since its inception encompassing a broad range of medical conditions, including COVID-19.Conclusion: The OPCRD represents a unique resource with great potential to support epidemiological research, from retrospective observational studies through to embedded cluster-randomised trials. Advantages of the OPCRD over other EMR databases are its large size, UK-wide geographical coverage, the availability of up-to-date patient data from all major GP software systems, and the unique collection of patient-reported information on respiratory health. [ABSTRACT FROM AUTHOR]

Introduction: Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics. Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics. Results: In April 2020, monthly requests dropped to 7.9–18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7–86.9% of 2019 levels. During April–June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4–63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April–June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April–June 2020; trend test p < 0.001) and two subsequent periods (July–September and October–December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group. Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59–86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality. [ABSTRACT FROM AUTHOR]

Background: Differential attainment has previously been suggested as being due to subjective bias because of racial discrimination in clinical skills assessments. Aim: To investigate differential attainment in all UK general practice licensing tests comparing ethnic minority with White doctors. Design and setting: Observational study of doctors in GP specialty training in the UK. Method: Data were analysed from doctors' selection in 2016 to the end of GP training, linking selection, licensing, and demographic data to develop multivariable logistic regression models. Predictors of pass rates were identified for each assessment. Results: A total of 3429 doctors entering GP specialty training in 2016 were included, with doctors of different sex (female 63.81% versus male 36.19%), ethnic group (White British 53.95%, minority ethnic 43.04%, and mixed 3.01%), country of primary medical qualification (UK 76.76% versus non-UK 23.24%), and declared disability (disability declared 11.98% versus not declared 88.02%). Multi-Specialty Recruitment Assessment (MSRA) scores were highly predictive for GP training end-point assessments, including the Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA), Recorded Consultation Assessment (RCA), and Workplace-Based Assessment (WPBA) and Annual Review of Competency Progression (ARCP). Ethnic minority doctors did significantly better compared with White British doctors in the AKT (odds ratio [OR] 2.05, 95% confidence interval [CI] = 1.03 to 4.10, P = 0.042). There were no significant differences on other assessments: CSA (OR 0.72, 95% CI = 0.43 to 1.20, P = 0.201), RCA (OR 0.48, 95% CI = 0.18 to 1.32, P = 0.156), or WPBA—ARCP (OR 0.70, 95% CI = 0.49 to 1.01, P = 0.057). Conclusion: Ethnic background did not reduce the chance of passing GP licensing tests once sex, place of primary medical qualification, declared disability, and MSRA scores were accounted for. [ABSTRACT FROM AUTHOR]

Background: Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. Methods: Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. Results: When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. Conclusions: Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles. [ABSTRACT FROM AUTHOR]

OBJECTIVES: From 2006, the Ministry of Education in China has approved universities to provide undergraduate medical training in English, targeting fee-paying international students. Students on these courses can face challenges in their clinical training, particularly in the domains of communication and professionalism. This study examines the proportion of doctors qualified from such medical schools who are currently listed on the UK medical register. METHODS: The UK General Medical Council register of medical practitioners was searched to identify doctors qualified from 33 Chinese medical schools who provide education in the English language. RESULTS: As of February 2022, 502 doctors whose primary medical qualification is from a university offering English language education in China were registered on the UK medical register. Four hundred twenty-five (84.7%) of these doctors were aged 39 and under, approximately double the proportion of doctors in this age bracket overall. Three hundred forty nine (69.5%) were staff grade and associate specialist doctors, 109 (21.7%) were doctors in training, 36 (7.2%) were on the General Practitioner (GP) register, and 20 (4.0%) were on the specialist register. Among doctors in training, the most common specialty areas were in general practice and psychiatry that are both facing recruitment shortages in the UK at present. CONCLUSION: A small but significant number of graduates whose medical training was in the English language in China are practicing medicine in the UK. These doctors are in younger age groups than the overall medical workforce, and are less likely to be in training, and specialist or GP posts. Among those in training, a high proportion are in GP and psychiatry training and could contribute to alleviating UK medical workforce shortages. Policymakers and educators should be mindful of the growing numbers of doctors qualified from these schools, and the additional support they may require considering the unique training environments they have encountered. [ABSTRACT FROM AUTHOR]

Introduction E-Cigarette voucher schemes have been piloted across the UK to support populations to quit smoking. This short report evaluates a scheme that targets vulnerable and disadvantaged smokers who had failed to quit smoking by other means. Methods Descriptive summary evaluation of service data on smoking outcomes and qualitative data from selected participants, as "key-informants" (n = 4) and key stakeholders (stop smoking staff, vape shop staff, and general practitioners [GPs]). Results In total, 668 participants were referred to the scheme, and 340 participants redeemed a voucher. By intention to treat analysis (ITT) 143/668 (21%) were recorded as quit smoking at 4 weeks. At 12 weeks, 7.5% of participants had quit, by ITT. Overall, the pilot project was well received by clients as it offered an affordable route into vaping for smoking cessation. GPs supported the scheme and appreciated being able to offer an alternative to entrenched smokers. Conclusions The scheme shows promise in supporting entrenched smokers to quit smoking. The offer of similar voucher schemes across the UK suggests the potential to reduce overall smoking prevalence and associated morbidity and mortality. Implications Working with GPs in a deprived area, it was possible to set-up a vape shop voucher scheme for smoking cessation. Patients with comorbidities who had tried and failed to quit smoking previously were referred to receive a vape shop voucher to be redeemed for an initial starter kit, alongside support from the stop smoking service. This innovative scheme enabled 42% of entrenched smokers who redeemed a voucher to successfully quit smoking within 4 weeks. [ABSTRACT FROM AUTHOR]

Background Being a general practitioner (GP) is a stressful occupation, and the strain GPs are under can have negative effects on their psychological well-being, as well as on the patients' experience of healthcare. Resilience can help buffer against this and is a dynamic process by which one can cope with adversity and stress. Aims This study aimed to identify modifiable cognitive mechanisms related to resilience in GPs, specifically interpretation bias and cognitive reappraisal. Methods One hundred and fourteen GPs completed an online cross-sectional correlational study. This comprised questionnaires assessing resilience, emotional distress, work environment and cognitive mechanisms (emotion regulation), as well as a task assessing interpretation bias. Results Resilience of GPs was negatively correlated with measures of emotional distress. Furthermore, resilience was positively correlated with positive interpretation bias (r = 0.60, ρ = 0.60, P < 0.01) and cognitive reappraisal (r = 0.39, ρ = 0.40, P < 0.01). In a hierarchical regression, positive interpretation bias (B = 0.25, SE B = 0.06, β = 0.39, P < 0.01) was a significant independent predictor of resilience when controlling for depression, anxiety and stress. Conclusions This is the first study to establish an association between resilience and positive interpretation bias and cognitive reappraisal in GPs. Future research should use longitudinal designs to determine if they have a causal role in promoting resilience, and importantly whether interventions focusing on these processes may foster resilience in less resilient GPs. [ABSTRACT FROM AUTHOR]

A polygenic risk score (PRS) quantifies the aggregated effects of common genetic variants in an individual. A 'personalised breast cancer risk assessment' combines PRS with other genetic and nongenetic risk factors to offer risk-stratified screening and interventions. Large-scale studies are evaluating the clinical utility and feasibility of implementing risk-stratified screening; however, General Practitioners' (GPs) views remain largely unknown. This study aimed to explore GPs': (i) knowledge of risk-stratified screening; (ii) attitudes towards risk-stratified screening; and (iii) preferences for continuing professional development. A cross-sectional online survey of UK GPs was conducted between July–August 2022. The survey was distributed by the Royal College of General Practitioners and via other mailing lists and social media. In total, 109 GPs completed the survey; 49% were not familiar with the concept of PRS. Regarding risk-stratified screening pathways, 75% agreed with earlier and more frequent screening for women at high risk, 43% neither agreed nor disagreed with later and less screening for women at lower-than-average risk, and 55% disagreed with completely removing screening for women at much lower risk. In total, 81% felt positive about the potential impact of risk-stratified screening towards patients and 62% felt positive about the potential impact on their practice. GPs selected training of healthcare professionals as the priority for future risk-stratified screening implementation, preferring online formats for learning. The results suggest limited knowledge of PRS and risk-stratified screening amongst GPs. Training—preferably using online learning formats—was identified as the top priority for future implementation. GPs felt positive about the potential impact of risk-stratified screening; however, there was hesitance and disagreement towards a low-risk screening pathway. [ABSTRACT FROM AUTHOR]

The article delves into the shift from a traditional General Practitioner (GP)-centric model to a multidisciplinary approach in primary healthcare, highlighting the enthusiasm and apprehension it stirs among practitioners. Topics include the evolving primary care ecosystem, challenges in accountability, communication complexities, shared decision-making, administrative burdens, and the redefined roles of GPs in managing teams and facilitating integrated care.

Background: The population of goats within the UK continues to rise and, according to latest Defra figures, now totals approximately 111,000 animals. With this comes the increasing likelihood that general practitioners will have something to do with these fascinating and characterful farmed species. The UK goat sector is one of the most diverse within the agricultural setting, being comprised of three main commercial wings: dairy, meat and fibre, and the remainder spread across pedigree and/or show stock, public attraction stock, small holder stock and those kept exclusively as pets. All these different settings have multiple and intertwining crossovers, which means the manner in which our caprine patients are kept, handled, managed and cared for can be equally disparate. The general practitioner must be aware of the circumstances and surroundings in which the animals are kept. Additionally, goats are generally of a gregarious and hierarchical nature, which can lead them into harm's way or mischief, and may necessitate various veterinary interventions. Aim of the article: This article, the first in a two part series, aims to equip general veterinary practitioners with the necessary knowledge and top tips for performing regional anaesthetic techniques in this species, while also highlighting how to stay on the right side of the law when it comes to available pharmaceuticals. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in burn care, large burn injuries carry significant mortality risk. Although studies examining immediate mortality are available, little data is available regarding risk after discharge from hospital. This study aimed to determine short and long term mortality rate at a UK burns centre for patients with massive burn injuries. We were particularly interested to determine whether mortality rate for self inflicted injuries was present and whether this was by suicide.Methods: The International Burn Injury Database (iBID) was interrogated to identify patients admitted with> 50% TBSA (total body surface area) injuries from January 2009- September 2019. Documented cause of death on death certificates were viewed for patients who died. General Practitioners were contacted to determine if discharged patients were alive. Descriptive statistics were generated.Results: 96 patients were identified. Mean age was 45.6 years (range 16.4-93.7) with male to female ratio of 2:1. Mean TBSA was 71.8% (range 50-99). Mortality was 71.9% and was higher in females (75.7% vs 69.8%). Overall mean revised Baux score was 130 (range 68-184). Nearly half were self-inflicted (49.0%) with higher TBSA (74.4%). Of 69 patients who died only 1 was after discharge. Coroner inquiry determined that this was caused by acute alcohol intoxication. Most of those who died did so within 60 days (91.3%), usually within 48 h (71.0%). Burn futility accounted for most deaths (71.0%) followed by multi-organ failure (14.5%).Conclusions: Large burns carry significant mortality risk. Self-inflicted large burns carry a higher mortality which may be attributed to larger TBSA. In patients surviving to discharge long term prognosis is good. Patients with self-inflicted burns seem to not make a subsequent successful suicide attempt after discharge from hospital. [ABSTRACT FROM AUTHOR]

Background: The UK introduced financial incentives for management of atrial fibrillation (AF) in 2006, after which there was an increase in the proportion of patients with AF diagnosed as resolved. Removal of incentives in Scotland provides a natural experiment to investigate the effects of withdrawal of an incentive on diagnosis of resolved AF. Aim: To investigate the effects of introduction and withdrawal of financial incentives on the diagnosis of resolved AF. Design & setting: Cohort study in a large database of UK primary care records, before and after introduction of incentives in April 2006 in Scotland, England, and Northern Ireland, and their withdrawal in April 2016 in Scotland. Method: Interrupted time-series analysis of monthly rates of resolved AF from January 2000--September 2019. Results: A total of 251 526 adult patients with AF were included, of whom 14 674 were diagnosed as resolved AF. In April 2006 there were similar shift-changes in rates of resolved AF per 1000 in England 1.55 (95% confidence interval [CI] = 1.11 to 2.00) and Northern Ireland 1.54 (95% CI = 0.91 to 2.18), and a smaller increase in Scotland 0.79 (95% CI = 0.04 to 1.53). There were modest downward post-introduction trends in all countries. After Scotland's withdrawal of the incentive in April 2016 there was a small, statistically non-significant, downward shift in rate of resolved AF per 1000 (0.39 [95% CI = -3.21 to 2.42]) and no change in post-removal trend. Conclusion: Introduction of a financial incentive coincided with an increase in resolved AF but no evidence was found that its withdrawal led to a reduction. [ABSTRACT FROM AUTHOR]