BJGP Interviews The British Journal of General Practice

In this episode, we talk to Dr Erica di Martino, a Research Fellow based within the School of Medicine at the University of Leeds.
Title of paper: Understanding General Practitioners’ referral decisions for younger patients with symptoms of cancer: a qualitative interview study
Available at: https://doi.org/10.3399/BJGP.2023.0304
Some cancers are becoming more common in younger people, yet clinical guidelines often recommend urgent referral for suspected cancer only if patients are above a certain age. Findings from this study show that, whilst most GPs interpret age criteria in cancer guidelines flexibly, some perceive and apply them as firm directives. In addition, system constraints may create unwarranted rigidity and act as barriers to prompt investigation. More in-built and explicit flexibility in the referral system is required to facilitate timely diagnosis of younger patients perceived as at higher risk by their GP.

In this episode, we talk to Becky Gudka, a Graduate Research Assistant based at the University of Exeter, about a study she’s published here in the BJGP titled, ‘Primary care provision for young people with ADHD: A multi-perspective qualitative study’. We’re also joined by her study co-author, Dr Anna Price, a Senior Research Fellow also at the University of Exeter who is the study principle investigator and senior author who led this research. 
Title of paper: Primary care provision for young people with ADHD: A multi-perspective qualitative study
Available at: https://doi.org/10.3399/BJGP.2023.0626
Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, with negative consequences for individuals and their communities. Research indicates a current “failure of healthcare” for people with ADHD in England, but previous recommendations to improve support for ADHD in primary care lack feasible and practical recommendations for health professionals. This study highlights individual-, practice- and system-level barriers to accessing support for ADHD via primary care and provides suggestions for how to overcome these barriers from the perspectives of multiple stakeholders. Health professionals and people with lived experience provided data which points to the standardisation of ADHD provision, providing additional information and support for clinicians, and better utilisation of reasonable adjustments for patients with ADHD in general practice.

In this episode, we’re taking a slightly different slant to talk to Dr Mark Levy, a GP based in London who led the National Review of Asthma Deaths and is a member of the Dissemination Working Group of the Global Initiative for Asthma (GINA). We’re talking to Mark as part of acknowledging World Asthma Day, which this year falls on 7 of May. 
Title of paper: Asthma deaths in children in the UK: the last straw
Available at: https://doi.org/10.3399/bjgp24X738201
Mark's website is also available here: https://bigcatdoc.com/ with additional resources and links to his own podcast.

In this episode, we talk to Dr Lynsey Warwick-Giles, a Research Associate based within the Centre for Primary Care and Health Services Research at the University of Manchester. 
Title of paper: Can Primary Care Networks contribute to the national goal of reducing health inequalities? A mixed method study
Available at: https://doi.org/10.3399/BJGP.2023.0258
Primary Care Networks are an important policy development in English primary care, with an additional contract supporting practices to work collaboratively. Policy makers intend that they will tackle local health inequalities. Our research suggests that there is potential for them to achieve this, but it will require: continued weighting of funding formulas to account for deprivation; redistribution of funds and other resources internally to support the most deprived practices; managerial support, particularly for PCNs with deprived populations; and realistic and achievable targets for PCN action.

In this episode, we talk to Dr Sahar Pahlavanyali, a doctor and PhD candidate based at the Department of Global Public Health and Primary Care at the University of Bergen in Norway. 
Title of paper: Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data
Available at: https://doi.org/10.3399/BJGP.2023.0211
There is a growing body of evidence on advantages of continuity, and a GP personal list is believed to be one of the positive measures to improve continuity, though not much researched. In a Norwegian setting with GP personal lists, we investigated the associations between GP continuity and mortality for patients with different chronic diseases. Our results showed that lower GP continuity was associated with increased risk of death, but the association was not significantly different for patients with the same RGP compared with those with different RGPs. This study suggests that high informational and management continuity provided by a GP personal list might lower and compensate for the adverse effects when changing GP.

In this episode, we talk to Dr Zoe Anchors, a Research Fellow based at the Centre for Health and Clinical Research at the University of the West of England. 
Title of paper: A qualitative investigation of the Additional Roles Reimbursement Scheme in primary care’
Available at: https://doi.org/10.3399/BJGP.2023.0433
The government has delivered on its commitment of recruiting 26,000 more primary care professionals through the ARRS in order to reduce patient waiting lists, widen the range of healthcare services and meet the needs of local populations. This qualitative analysis supports the positive impact of these additional roles in broadening the healthcare available to patients, and finds similar challenges (i.e., lack of career progression and supervision; lack of understanding of role descriptions and scope creep; problematic roadmaps; and poor integration) to implementation previously identified. However, our data reveals the scheme’s inflexibility and lack of available workforce particularly impacted Primary Care Networks in deprived areas resulting in the potential exacerbation of health inequalities, with the needs of populations not necessarily being met. More flexibility needs to be provided about who and what is funded under the scheme, with particular focus in areas of higher deprivation.