Today, we’re speaking to Dr Joy McFadzean,a GP in Swansea and Clinical Lecturer of Patient Safety based at Cardiff University. We’re here to talk about the paper she’s recently published here in the BJGP alongside her colleagues titled, ‘Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England’.

Title of paper: Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England

Available at: https://doi.org/10.3399/BJGP.2025.0239

Using a mixed-methods descriptive and framework analysis, this paper provides new insights into the complexity of care delivery in prisons. Results resonate with and strengthen the recommendations from recent investigations into prison healthcare by further developing an understanding of the complex intersecting factors contributing to safety incidents and quality issues in care delivery. The fundamental importance of good quality and adequately resourced primary care delivery in prisons has been highlighted. It also identifies system-wide interventions that are needed to improve care delivery, and which are likely to interest policy-makers and scrutiny bodies, commissioners and teams working in prisons to inform developments in strategic health needs assessments, workforce profiling, and training requirements for healthcare and prison teams.

Funding

This study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit.

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 - 00:01:10.200

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Welcome back to the first season of the BJGP podcast here in 2026.

And we're starting off this season of the podcast with a chat with Dr. Joy McFadyn. Joy is a GP based in Swansea and clinical lecturer of Patient safety based at Cardiff University.

We're here to talk about the paper she's recently published here in the BJGP alongside her colleagues. The paper is titled Critical Illness in Prisons A Multi Method Analysis of Reported Healthcare Safety Incidents in England.

So, hi, Joy, it's really lovely to meet you and to talk about this research, but yeah, just taking a step back, I think it's fair to say that the prison population is an underserved and probably fairly under researched population as well.

But you point out here in the paper that it's not only this, but that the prison population is actually at a much higher risk of early mortality as well. So can you talk us through this at all?

Speaker B

00:01:10.680 - 00:02:31.010

Yeah, that's a really good point. So we know that people who reside in prison, known as prisoners, will have very high rates of physical and mental health needs.

And as you say, there are concerns that they have rates of premature mortality, so they may die up to 20 years earlier than the rest of the population. But they are a population which isn't necessarily the area of focus.

So even though we know the importance of supporting their healthcare as a public health concern, they are often underserved, they're quite vulnerable, and yet there hasn't been enough research to support them to have...

Today, we’re speaking to Dr Rob Perry, who is a Gastroenterology Clinical Research Fellow based at Imperial College London.

Title of paper: Evaluating the Role of Faecal Calprotectin in Older Adults

Available at: https://doi.org/10.3399/BJGP.2025.0169

There is considerable uncertainty surrounding the use of FC as a diagnostic test in older adults, with varying suggestions in guidelines and a lack of data in the wider literature. This study investigates the performance of FC in older adults (≥50 years), compared to a younger cohort, with a view to guide its correct use in a primary care setting. These data suggest that FC is a sensitive test for IBD and organic gastrointestinal pathology in both groups. However, concerns remain over its PPV and specificity, particularly in older adults, and it should not be used if colorectal cancer is suspected.

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

00:00:00.880 - 00:00:49.180

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for taking the time today to listen to this podcast. Today we're speaking to Dr.

Rob Perry, who is a gastroenterology Clinical Research Fellow based at Imperial College London. We're here to talk about the paper he's recently published here in the BJGP titled Evaluating the Role of Fecal Calprotectin in Older Adults.

So thanks, Rob, for joining me here to talk about your work.

And I guess I just really want to preface this by saying that a lot has changed in the last few years just in terms of testing for inflammatory bowel disease and bowel cancer in general practice. But I wonder if you could just talk us through this, some of the different guidelines and why you wanted to do this study.

Speaker B

00:00:49.660 - 00:02:24.450

Oh, yes, thank you for having me.

Firstly, and the rationale for the study is that, you know, consultations for gastrointestinal symptoms make up a large number of consultations in primary care. I think the figures around 10%.

And whilst fecal cow protection is an increasingly well established test for differentiating between inflammatory bowel disease and functional or other gastrointestinal or non inflammatory gastrointestinal diseases, its role in older adults is far less well established.

With varying guidelines for clinicians in primary care, the NICE guidelines make no specific mention, for example, of age, other than that calprotectin should not be used where age is considered a risk factor in the context of certain symptoms. For suspicion of cancer, the BSG guidelines on IBD use a cutoff of 40, above which they suggest calprotectin is not used.

The something called the NICE York Fecal cow protectant care pathway suggests an age cut above 60, which is a NICE endorsed pathway. So there's some uncertainty there in the literature about which cutoff should be used for fecal cow protectin.

And the reason any cutoff is suggested is because data has previously shown that calprotectin lacks sensitivity for diagnosing colorectal cancer.

And as age is considered a risk factor for colorectal cancer, guidelines normally mandate earlier endoscopic evaluation of patients with GI symptoms in older age groups.

Speaker A

00:02:24.530 - 00:02:39.170

And can you just talk us through briefly what you did here? So you looked at patients referred for a colonoscopy at one single centre, so at Imperial College Healthcare Trust.

But just talk us through...

Today, we’re speaking to Flo Martin, an honorary research associate at the University of Bristol.

Title of paper: First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLD

Available at: https://doi.org/10.3399/BJGP.2025.0092

Antidepressant use during pregnancy is rising, with concerns from pregnant women that these medications may increase the risk of miscarriage if taken prenatally. Evidence is conflicting so we used the Clinical Practice Research Datalink, a large repository of UK-based primary care data, and a range of methods to investigate antidepressant use during trimester one and risk of miscarriage.

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

00:00:00.240 - 00:00:52.800

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Dr. Flo Martin, an honorary research associate at the University of Bristol.

We're here to look at the paper she's recently published here in the BJGP titled First Trimester Antidepressant Use and Miscarriage A Comprehensive Analysis in the Clinical Practice Research Data Link. Gold. So, hi, Flo, it's great to meet you and talk about this research.

And I think this paper touches on an area that clinicians and women often approach with a bit of uncertainty, just in terms of prescribing safety, really, in pregnancy in general. But can you talk us through what we know already about prescribing for antidepressants and risk in pregnancy, just to frame what you've done here?

Speaker B

00:00:53.280 - 00:02:22.860

Yeah, absolutely.

So we actually did some work a couple of years ago doing a systematic review of the literature in this space, so looking at antidepressant use during pregnancy and the risk of miscarriage. And the work spanned the last kind of 30 years.

And what we found was a 30% increase in risk of miscarriage following antidepressant use during pregnancy. And this was obviously kind of alarming to see this increase in risk. But the kind of key takeaway from the paper was not actually this finding.

It was mostly the kind of variation in the literature that we observed when answering this question.

We kind of were very cautious about interpreting this 30% increase in risk as a kind of true causal effect because we had observed these other things that might be driving the estimate kind of upwards and might not necessarily show the true effect that was happening in this population. So that was kind of the environment that we were existing in before we started the study.

And it really informed the way that we wanted to do this study.

So we thought it was really important to try and understand that baseline risk in both unexposed and exposed pregnancies, so that whatever we observed was contextualized against what the underlying risk was among those who hadn't been prescribed antidepressants.

Speaker A

00:02:23.500 - 00:02:58.120

Yeah, fair enough.

So this is a large analysis of the clinical practice research data link, and you looked at pregnancies between 1996 and 2016 and then followed up women who had been prescribed or not antidepressants and risk of miscarriage.

And I think if people are specifically interested in how you did this, they can go back to the paper and look at some of the different methods you used. But I...

Today, we’re speaking to Claire Mann, a Research Fellow who is based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate Professor based at the University of Birmingham.

Title of paper: Accessing Equitable Menopause Care in the Contemporary NHS – Women’s Experiences

Available at: https://doi.org/10.3399/BJGP.2024.0781

Menopause awareness has increased in recent years, as well as HRT use, however, this has not been experienced equally. Cultural influences such as stigma, preferences for non-medical approaches, perceptions of ailments appropriate for healthcare, lack of representation, work against women seeking help. GPs should not assume all women who would benefit from HRT will advocate for it. They ought to initiate discussions about potential HRT, as well as other approaches, with all presenting women who may benefit.

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

00:00:00.240 - 00:01:12.020

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're talking to Claire Mann, a research fellow who's based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate professor based at the University of Birmingham.

We're here to discuss the recent paper published here in the BJGP titled Accessing Equitable Menopause Care in the Contemporary NHS Women's Experiences. Thanks, Claire and Sarah, for joining me here today to talk about this work.

This study focuses particularly on the women's experience of menopause and accessing general practice and primary care. But I'll point out just before we begin that you've also published a linked paper looking at the clinician perspective.

So anyone who's interested in that angle should look up your other paper. But back to this one. Sarah, I wonder if I could start with you first.

I wonder if you could just talk us through the focus of the paper here and the kind of disparities that different women might face in accessing menopause care in the UK.

Speaker B

00:01:13.620 - 00:02:57.750

Essentially, this work came about because in 2020, we published a piece of work in the BJGP that looked at prescribing a practice level of hrt.

And what we found was that actually, if you were a patient at one of the most deprived practices in England, you were about a third less likely to be prescribed HRT than if you were in the most affluent. What we didn't have at that point in time was data at an individual level, just at a practice level.

But it was important that work was done because that really pushed that forwards. But what we didn't understand was what was going on underneath that. So.

So we asked the nihr, we wrote a grant for something called Research for Patient Benefit and said, look, we want to explore exactly why there is this disparity, because our feeling as researchers was that it wasn't straightforward and that there was a lot going on, both from the woman's perspective and the healthcare professional's perspective. And we really wanted to know exactly how that was all adding up to this gap in prescribing.

What we did was we spoke to 40 women, but we were incredibly mindful that we wanted to speak to women that were less likely on paper to be prescribed hrt. So we tried to speak to women that were from more socially economically deprived areas and also black and South Asian women.

So this project

Today, we’re speaking to Dr Luisa Pettigrew, a GP and Research Fellow at the London School of Hygiene and Tropical Medicine and Senior Policy Fellow at the Health Foundation.

Title of paper: Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitioners

Available at: https://doi.org/10.3399/BJGP.2024.0833

There have been successive Government promises to increase GP numbers. However, the numbers of GPs in NHS general practice depend upon how GPs are defined and how data are analysed. This paper provides a comprehensive picture of trends in GP capacity in English NHS general practice between 2015 and 2024. It shows that the number of fully qualified GPs working in NHS general practice is not keeping pace with population growth and there is increasing variation in the number of patients per GP between practices. We offer research and policy recommendations to improve the consistency and clarity of reporting GP workforce statistics.

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 - 00:01:04.810

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Dr. Louisa Pettigrew, who is a GP and research fellow at the London School of Hygiene and Tropical Medicine.

Louisa is also a Senior Policy Fellow at the Health foundation and we're here today to talk about the paper that she's recently published here in the bjgp. The paper is titled Counting A Comparative Repeat Cross Sectional analysis of NHS GPs.

So, hi, Louisa, and thanks for joining me here today to talk about your work. And I guess just to set things out, it is really important to know how many gps there are working.

But I wonder if you could just talk us through what we already know about this. We know that there have been successive government policies and promises to increase the number of gps.

There are, as we know, different ways that gps could be counted.

Speaker B

00:01:05.530 - 00:02:37.470

So, yeah, as you rightly point out, there's been recurrent governance promises to increase GP numbers.

Not just our current Labour government, but the previous Conservative government too, and previous governments too, because they realize that, you know, having access to GP is important for the public and there's a shortage, a perceived shortage of them.

So the issue that we notice that there's different ways to count GPs who are working NHS General practice, and therefore depending on how you choose to count them, then that affects the trends and it affects your numbers.

So you can count a GP by headcount, whether they're working in NHS general practice or not, and you can count them by full time equivalent, so the actual reported numbers of working hours. You can also consider GPs to be fully qualified GPs alone, or you could include GPs who are fully qualified, plus what is categorized as GP trainees.

Now, that category includes GP trainees, but it also includes foundation year one and two doctors and any other sort of junior doctor that might be in general practice. And the other dimension to how you count gps is whether you take population growth into population size.

So in the UK, over the past, sort of between 2015 and 2024, which was a period of analysis of our study, there was about 12% increase in population size in England. So once you take population growth into...

Today, we’re speaking to Jadine Scragg, a researcher based at the University of Oxford, and Sabrina Keating about their recent paper published here in the BJGP.

Title of paper: GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in England

Available at: https://doi.org/10.3399/BJGP.2025.0065

General practitioners (GPs) play a central role in managing obesity yet face significant challenges due to limited treatment options and resource constraints. GLP-1RAs are emerging as a promising treatment for obesity but access in primary care is limited. This study provides new insights into GPs’ perspectives on the integration of GLP-1RAs into primary care, highlighting concerns around resource limitations, health equity, and misuse of the medications.

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

00:00:01.200 - 00:01:00.730

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.

Today we're speaking to Judine Scragg, a researcher based at the University Oxford, and Sabrina Keating, a DPHIL student who's also based at the University of Oxford within the Nuffield Department of Primary Care Health Sciences.

We're here to talk about their recent paper, published here in the BJJP, titled GP's Perspectives on GLP1 Receptor Agonists for Obesity Management A Qualitative Study in England. So, hi, Judine and Sabrina, it's great to meet you both for this chat.

I guess the first thing to say is that this work is really topical at the moment, especially given current plans to increase the rollout of GLP1 receptor agonists into the community. But, Judine, I'll come to you first and I wonder if you could just tell us a bit more about what you wanted to do in this research and why.

Speaker B

00:01:01.510 - 00:02:25.330

Yeah, absolutely. So, for a long time, as you've said, the GLP1s have been very topical, both in clinical groups and with patients as well.

So I'm first and foremost, I'm a weight management researcher and I've done work in populations with people living with type 2 diabetes and polycystic ovary syndrome. And within those populations, one of the things they've constantly asked about is about GLP1s, when do I qualify? When do I get it around?

And similarly with the gps GP groups as well, there's been a lot of questions, there's lots of media about, you know, both good and bad about GLPs and outlining different people's thought processes and are they good? Are they bad?

So what we sought to do with this was to sort of more robustly work out what it is GPs actually feel about the perceived integration of the GLP1s into primary care to very kind of firmly focus on GP specifically.

And this ended up coming at a really timely point, as midway through the study, the NICE guidance was brought out on outlining the plans for how tirepatide would be rolled out. So it was a really timely piece to find out exactly what they were thinking and feeling about how this may impact them and their patients.

So that's really what we set out to do.

Speaker A

00:02:26.200 - 00:02:55.660

Great.

And this was a qualitative interview study of 25 GPs across England working across different roles, and they all had different experience in weight management services. But I really Just wanted to come on to what you found here.

And let's start with an area that's quite a common issue right now, and I...

Today, we’re speaking to Dr Steph Stockwell, a senior analyst based at RAND Europe.

Title of paper: Evolution of the general practice receptionist role and online services: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2024.0677

The introduction of online systems and services into general practice and the impact on general practice staff has been considered from a clinician perspective, but comparatively little is known about how these introductions have affected the receptionist role. This study highlights that the use of online services is leading to an evolution of the general practice receptionist role. The role is becoming increasingly complex as practices use multiple online systems, which impacts demand management and navigation aspects of the role. Online systems have variable consequences on workload for receptionists, which has potential implications for workflow, consistency of task completion, job satisfaction, and retention and recruitment of these key staff members.

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 - 00:00:53.350

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.

In today's episode, we're speaking to Dr. Steph Stockwell, a senior analyst based at RAND Europe.

We're here to discuss the paper she's published here in the BJGP titled Evolution of the General Practice Receptionist Role and Online Services A Qualitative Study.

So, hi, Steph, it's great to meet and talk about this work and one of the reasons I really wanted to talk about this is that I think it's timely work, given that we know there's an increasing emphasis just in general practice on triage and also the multidisciplinary team. You talk in the introduction of this paper just about the role of receptionists, which has been evolving and changing in recent years.

So just talk us through that a bit.

Speaker B

00:00:53.720 - 00:02:09.550

Yeah. So this work came about because we were doing some work for the wider de facto study, which was a.

An observational, mixed methods study that involved delete reviews, some surveys, ethnographic case studies and some interviews.

And it was whilst I was doing some of the ethnographic case study work that we spent a lot of time around reception staff because they were the ones who were doing most of the digital facilitation, which is the phenomena that we were. Were looking at. It was whilst doing these observations that the idea for this, this paper came to me, as, you know, often the.

The first point of call for, for patients making contact with general practice and they're really crucial for helping to manage that demand and facilitating patient access to care.

But during these observations, I noticed how the perception of what a receptionist did, particularly among patients and the public, was a little bit outdated and the array of technologies and platforms that they were having to manage and, and help patients use as well, was really sort of the stereotype of answering telephone calls.

So, yeah, the rationale for this work sort of came about on the back of that and it made me want to look back at some of the work that we did for the De facto study and to see what sort of impact the online services had on the role of GP receptionists.

Speaker A

00:02:10.030 - 00:02:50.390

Yeah. So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of...

Today, we’re speaking to Dr Sophie McGrath, Consultant Medical Oncologist based at the Royal Marsden NHS Foundation Trust and at Kingston Hospital in London.

Title of paper: Management of menopausal symptoms following treatment for hormone receptor positive breast cancer

Available at: https://doi.org/10.3399/BJGP.2025.0264

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 - 00:01:11.660

Hello and welcome to BJJP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for joining us today to listen to this podcast.

In today's episode, we're speaking to Dr. Sophie McGrath, who is a consultant medical oncologist based at the Royal Morrison NHS Trust and at Kingston Hospital in London.

We're here to talk about the recent analysis article that she and her colleagues have published here in the BJDP titled Management of Menopausal Symptoms Following Treatment for Hormone Receptor Positive Breast Cancer.

And just to point out that these colleagues included not just medical oncologists, but also GPs and patients, which I think has really shaped this article and is one of the reasons why we wanted to highlight it here in the podcast. So, hi Sophie, thanks for meeting me to talk about this article, which I think touches on a really important topic in practice.

But talk us through some of the initial side effects that you discuss in the introduction here. Just in terms of hormone positive breast cancer, what kind of symptoms do women experience generally as a result of endocrine therapy?

Speaker B

00:01:12.220 - 00:02:32.900

So, yeah, thanks very much for asking. And it's a bit of a broad answer that I would give.

I mean, I've focused on, or we have focused on three main symptoms within the article which relate to hot flushes or vasomotor symptoms, also to joint stiffness and pain and swelling, arthralgia, and also to vulvovaginal symptoms, otherwise known as genitourinary syndrome of menopause.

But I think what we've tried to include within the article as well is a table that certainly acknowledges that there are unfortunately many other symptoms that women can get as a result of these medications, essentially mimicking menopausal side effects.

And of course, you know, these might be symptoms that women having already gone through the menopause may have suffered or experienced at some point already.

But actually for a population of premenopausal women, these will be symptoms that they haven't had any experience of yet and can often be quite intense and develop quite suddenly. Whereas often our post menopausal women have had some sort of lead up to this, they've had some experience.

Speaker A

00:02:34.710 - 00:02:44.710

And you work as a medical oncologist. But just talk me through your own experience of working with women who are going through the sort of sudden menopause as you describe as well.

Speaker B

00:02:45.350 - 00:05:50.240

So obviously the focus of the article here is on menopausal side effects in general from the treatments that we use. And we've talked a lot about using our endocrine treatments such as tamoxifen, letrozole.

But actually many of our women also experience menopausal type side effect secondary to the chemotherapies we give them. So I think, you know, there's sort of two groups you often have, particularly premenopausal women who stop their periods whilst on chemotherapy.

That may happen several weeks into their chemotherapy treatment and it can be quite sudden.

You know, they're already dealing with the numerous side...