BJGP Interviews

In this episode, we look back at the last season of the BJGP podcast and reflect on some of the work we’ve discussed. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.560 - 00:11:08.620Hi, and welcome to the BJGP podcast. I'm Nada Khan, one of the associate editors of the Journal.And we've reached the end of another podcast season, and before we take a short break for the summer, we thought we'd look back at some of the papers we've covered and pick out a few highlights and common threads between them.And looking back at the different podcasts over this this past season, it seemed that although each conversation started with a completely different research question, by the end we all seemed to be talking about the same thing, and that was, how can general practice work better for patients in today's increasingly complex healthcare system?And although we talked about a wide range of different topics, we covered cancer diagnosis, dementia, women's health, medical education, and we even talked to Garth Funston about artificial intelligence. They all came back to this same underlying challenge.And we know that general practice has always dealt with complexity, and that's not really anything new, but the kind of complexity we're dealing with now feels different. Patients are living longer with multiple conditions. Care is spread even more so across increasing numbers of services than ever before.Technology is changing the way that we work, and somehow, amongst all that, we're still trying to preserve those relationships that have always sat at the heart of general practice. And I think another thing that really struck me was that very few of the papers and researchers were talking about making dramatic changes.And instead we had a lot of discussions about how we could make systems we already have, just work a little bit better. So making it easier to navigate, getting people more connected, more equitable, and more human as well.So one of the first interviews we recorded was with Katharina Savolkul about why medical students choose or don't choose a career in general practice. And on the surface, it's comes across a bit like workforce paper.We know that we need more gps, and understanding career choice is clearly important, but I think we talked about something a little bit bigger, which is, what kind of profession are we asking people to join? And this review highlighted positive GP placements, so good role models and the hidden curriculum as well.And although we often focus on recruitment targets, Katharina reminded us that students choose career because of the experiences they have and the values that they see lived out.And interestingly, continuity of care remains one of the biggest reasons people are still drawn towards becoming GPs, even though many of us worry that that's becoming harder to achieve in practice. And I think that continuity became one of those defining threads that ran through a lot of the interviews that followed.And we had Ewan Lawson join the podcast to speak to Charlotte Morris about dementia care. And what they talked about was that participants weren't really asking for more investigations or different medications.What they wanted to feel was to be known and to have someone who understood who they were before their diagnosis recognize those changes over time and stayed alongside them as their condition progressed.And I guess listening to that interview made me realize that it's not just about seeing the same gp, but it's about patients feeling that someone is carrying the thread of their story over time. And I had a really similar feeling talking to Dr. Tory Ford about recurrent vulvovaginal thrush.And these were two qualitative papers about diagnosis and healthcare experiences. But I think by the end of the interview, we were talking about something much broader.And as clinicians, we think sometimes about those bite sized consultations, but patients don't at all. At least this was the experience that I think that we drew out from Tori's work.And in this work, I think Tori highlighted that people experience illness as a continuous journey. And although in a system where continuity of care might be challenged, clinicians might see episodes of care, but patients live their whole story.And I think that's why sometimes recurrent conditions can feel so frustrating for patients, not because, particularly those individual episodes of care consultations are poor, but because if there's discontinuity, no one's joining those consultations together.And I think the more interviews we recorded, I pulled out another pattern, and that's that whether we're talking about dementia, recurrent thrush, pediatric safety or postnatal care, patients and families were doing a lot of work.So an extraordinary amount of invisible work, they were chasing referrals, following up on test results, explaining the same story repeatedly to different professionals.And although these papers weren't a criticism of general practice, and oftentimes many of the patients talked about how much they valued their GP teams. But I think that it almost made it feel as though patients and families were bridging these gaps together between increasingly fragmented services.And I think that Tom Purchase's work on pediatric patient safety really captured this beautifully. So rather than seeing patients just as recipients of health care, his study showed that they're active contributors to safer care.So they're already preventing harm. Patients and their families are identifying problems and improving systems.And I think he challenged us to think about patients as partners in care, rather than just recipients of care. Another theme that kept surfacing was inequality.And I spoke to Eliza Hutchinson about her work in inflammatory skin disease in People with skin of color.And her participants talked about delayed diagnosis, underrepresentation in medical education, and that impact of dyspigmentation as well in practice.And I think, again, what stayed with me wasn't just the clinical message, which was really helpful, and I'd encourage gps to go back to listen to that, but it's how often people really just wanted their experiences to be recognized.And similarly, I think that Claire MacDonald's work on postnatal care reminded us that women with the greatest social needs are often face the biggest barriers to access and care after birth. And ironically or sadly, this is just as services begin to step back.And I guess these two papers were asking a much broader question was how do we design healthcare systems that work equally well for everyone?And I think one of the papers that I really enjoyed, or one of the people I really enjoyed talking to, was Garth Funston and his work using large language models to analyze free text consultation records, aiming to pick up earlier signals for ovarian cancer. And I think that, you know, we.We talk a lot about artificial intelligence, but actually what we ended up talking about was how we record things in consultations.And as gps, we write huge amounts that really never get coded as read codes in the system or snowbed codes, you know, symptoms, concerns, uncertainty, those details that really make up the richness of a consultation. And I think that what Garth's work showed us was that AI might help us make better use of the information we've already recorded.But I think that actually, you know, it's worth thinking about how we're actually using technology to help recover the stories we've already written in the free text as well.And the last thing that we talked about in this season was something that probably every GP understands instinctively, but few of us have actually been explicitly taught, and that's prioritisation. And we spoke to Andrew McClary about the rapid decisions we make every day. So which patient do we call first? What referral can wait?And crucially, what do we do first? Do we tackle the difficult task or go for the quick wins?And I think that I liked the title of his work, because I suspect every GP probably immediately recognized them themselves somewhere between these two approaches. And I think we also touched upon that prioritisation isn't simply about managing workload, but it's also about managing uncertainty.And I think that if there's one thing I'll take away from this entire season and the different people that we've talked to and the great work that we've listened to, I think it's that general practice has always been about managing complexity. But these conversations reminded me that complexity isn't something we can just eliminate or fix.It's something that it's worth delving into to try to understand a little bit better.And I think, you know, whether we're talking about continuity, inequalities, patient safety, or the workforce force, another common thread I thought that ran through these, these conversations was that connection.So connecting services together, connecting research with everyday practice, and staying connected to patients and the stories that they bring with them through time, really.And I guess for me, really, every interview this season left me thinking a little bit differently about how I, how I consult and practice and about that...

Today, we’re speaking to Dr Tom Purchase, a GP and Health and Care Research Wales NIHR doctoral fellow.Title of paper: Co-generating ideas for safer paediatric care in general practice with parents and stakeholdersAvailable at: https://doi.org/10.3399/BJGP.2025.0690Research has highlighted the important role parents play in in paediatric patient safety, for example, through mitigating safety incidents in general practice, yet their perspectives have rarely shaped system-level improvements. This study co-generated and prioritised ideas for change with parents and key stakeholders, identifying feasible and impactful strategies to improve paediatric safety in primary care. These strategies centred around practice communication, accessing care records and results, and fostering a culture of shared learning and development. Parents are willing and able to contribute meaningfully to safety improvement efforts, and their insights align with national patient safety priorities. Clinicians and policy makers can use these findings to strengthen collaboration with families, tailor safety interventions to local needs, and embed parent voices into the design of safer care systems.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:00:49.500Hello and welcome today to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening again to this podcast.In today's episode, we're talking to Dr. Tom Purchase. Tom is a GP and a health and Care Research Wales NIHR Doctoral Fellow.We're here today to talk about the paper he's just published in the bjgp and the paper is titled Co Generating Ideas for Safer Pediatric Care in General Practice with Parents and Stakeholders.So, hi, Tom, it's really great to meet you and to talk about your work, but before we talk about the study itself, I'm interested to know what first got you interested in pediatric patient safety in general practice.Speaker B00:00:50.060 - 00:02:26.850Thanks. It's born, I think, out of an extension of the work that we've been doing within the patient safety team within Cardiff University.So a lot of what we do is looking at incident reports, safety incident reports, and trying to pick out what are the, you know, high level key learning points and takeaway messages from those.And then within the team, we started to think about, as well as the types of incidents and the types of harms that are occurring within pediatric incidents. For example, how are parents involved?And it was a bit of a novel approach to what we normally do, trying to have that extra aspect within the incidents and figuring out how parents were either helping to contribute or to mitigate against the incidents, not just looking at the incidents themselves. So that was the starting point, really.And then once we'd started digging into that data and identifying that, actually the majority of the time, which is in one of the papers that was published last year in BJGP, 77% of the reports we were looking at specifically around general practice showed that parents were taking these mitigatory actions that, you know, positive actions that were able to prevent harm or further harm from occurring to their child, for example, chasing results or chasing referrals or importantly, being able to speak up. And then that highlighted, I think, the importance of parents being able to have a voice and advocating on behalf of their child.And that really sparked, I think, the interest, and therefore this part of the.Speaker A00:02:26.850 - 00:02:46.490Project, and I think that's a really interesting thing about this paper, is that it focuses on parents and parents not just as observers of care, but as active contributors to safety. And I wonder what your thoughts are about why that's an important shift in how we think about these things.I think you've touched on it a bit, but yeah, I'm interested to know a bit more about that.Speaker B00:02:46.810 - 00:03:55.980I think it is a really important aspect of care, but also particularly safety, which maybe is untapped in terms of parents as a resource as to how we can keep children safe.We know that children on the whole are more, maybe not more vulnerable, but certainly are a vulnerable group when it comes to patient care in general and patient safety.And that's because they're so heavily reliant on others to speak on their behalf, to make sure somebody else is looking out for their healthcare needs. And therefore they are probably playing a part within the world of patient safety.And there are good studies from hospital relating to incident reports that show that parents are capable of picking up issues early on. They're able to detect issues that maybe other parts or people within the system aren't detecting.And as I mentioned, our paper from last year specifically looking at general practice showed that parents are able to prevent harms from reaching their children. So they're playing a substantial part already.And from a systems perspective, that is mainly parents figuring out workarounds within a system that really isn't, I don't think, designed to support them as well as it could be.Speaker A00:03:56.460 - 00:04:33.810And I guess that's kind of the crux of what you were doing here.So I guess before we get into findings, just, you know, a quick word about the methods because you worked here with groups of parents to develop ideas for improving pediatric patient safety in, in general practice, in primary care, and then you explored those ideas with a wider group of stakeholders and that included clinicians, managers and policymakers, and then brought them all together to co generate ideas for safer care. And it was really interesting because the parents generated 16 different ideas for improving safety.And were there any that particularly surprised you and jumped out at you?Speaker B00:04:34.450 - 00:05:33.980I don't think necessarily any were too surprising on the basis that we. I don't think I really had any thoughts going into it as to what they might say.But I guess what did surprise me more was that some of the ideas that we then took forward to the stakeholder group kind of highlighted some disparities or some clear disagreements between the parents who were accessing our services and the people who work within the services. And how we viewed, I suppose, viewed what's actually happening, that kind of work is imagined and how we think things are going and the work is done.I guess what the parents were trying to do to come up with the idea is to bridge that gap unknowingly. I suppose maybe what's surprising is that none of them, I didn't think any of the ideas were necessarily too resource intensive.You know, I think what was quite reassuring is that lots of what the parents were saying were actually relatively simple things that we might be able to enact or at least adopt or adapt, you know, to our own environments.Speaker A00:05:34.540 - 00:05:47.730And a lot of the ideas seem to center, I think, around communication, access to records and test results, and actually just helping parents to speak up. And why do you think those themes emerge so strongly?Speaker B00:05:48.450 - 00:07:24.990I think that comes back to maybe that difference between how we like to think the system's functioning and how parents think the system's functioning as healthcare professionals and parents.Because we know from a thematic analysis we did, which is also going to be published in bjgp, from these discussions we've had with the parents, that a lot of them said they felt the need to fight in order to be heard.So although within, say, pediatrics and GP training programmes and CBDs and everything we have to do for revalidation, taking ideas, concerns, expectations, collateral histories, making sure we're really considering that the holistic approach is all considered clinically, what you're then getting, I suppose, from the parents is that maybe we're not doing it as well as we could be.And one parent within the workshop said, I know as a parent you are expected to advocate for your child, but what it surprises me is how regularly you have to do it and sometimes it feels like a full time job.And I think that one really struck a chord in terms of really emphasizing how much extra effort and how much work parents are feeling they need to put in. And I think that also implies that the system isn't making it as easy as possible for them to be able to do the right thing.So I can't necessarily explain unfortunately why they feel that those areas needed to be targeted.I guess it's because there are barriers that we are not tackling correctly in order to help parents to speak up more efficiently and certainly to be listened to.Speaker A00:07:26.840 - 00:07:35.160And one of the stakeholder priorities was this idea of a designated parent advocate. Can you tell us a bit more about that idea and why it resonated?Speaker B00:07:35.640 - 00:09:21.810Yeah, sure.I really liked that one and I thought it was an interesting one because again, it...

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 GOLDAvailable at: https://doi.org/10.3399/BJGP.2025.0092Antidepressant 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.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.240 - 00:00:52.800Hello 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 B00:00:53.280 - 00:02:22.860Yeah, 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 A00:02:23.500 - 00:02:58.120Yeah, 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 wanted to focus really on what you found here.And I think the first thing to point out is that it wasn't uncommon for women to have a prescription for an antidepressant in that first trimester of pregnancy. So talk us through that.Speaker B00:02:58.440 - 00:03:43.270Yeah, exactly. So I think we. We kind of report about 7% of the pregnancies in our study that had been prescribed antidepressants.And I think, as you say, this is, you know, potentially higher than what you would expect. I think there are kind of multiple things driving this.If we look outside of pregnancy and kind of zoom out and look at the prescribing rates of antidepressants in both men and women, we can see it's going up, you know, between the 1990s and the late sort of 20 teens. And.And I think, yeah, people will be maybe surprised to see, but it's very, you know, on trend with what we're seeing outside of pregnancy and then looking.Speaker A00:03:43.270 - 00:03:45.950Specifically at the risk of miscarriage here. What did you find?Speaker B00:03:47.150 - 00:04:59.060Yeah, so when we applied our kind of primary analysis where we were looking at pregnancies who had been prescribed antidepressants in trimester one, and comparing them to pregnancies who were not prescribed antidepressants in trimester one, we found a very, very small increase in relative risk. So I think we found about 4% increase in risk of miscarriage among the prescribed group than. Than the non prescribed.And what this translated to in terms of that baseline risk, we observed 13.1% of those not prescribed antidepressants, they experienced a miscarriage, and this increased to 13.6% among those who were prescribed. So I think that really puts into perspective when we talk about increases in risk, this is an incredibly modest one, an increase all the same.And it's important to not kind of trivialize that increase in risk.But I think it's also incredibly reassuring that when we kind of really place it within what the underlying risk is had someone not taken antidepressants, it's very, very small.Speaker A00:04:59.620 - 00:05:00.100Yeah.Speaker B00:05:00.180 - 00:06:32.630Yeah. I think this is a really important piece of the puzzle for risk communication.Being able to show relative increases in risk, which are incredibly useful alongside what that actually means in terms of the percentage, the proportion of people that experience an outcome, because it just reminds people that, you know, clinicians and patients alike, that this isn't something that you have complete control over. This isn't purely your behavior driven. It's not.So I think that can be really kind of reassuring for Individuals who feel that kind of burden of risk mitigation.We see it in Heather James's paper in BJDP last year, a beautiful qualitative study speaking to women who had experienced antidepressant use during pregnancy and talking through their decision making process and their fears and concerns.And a couple of the participants who were involved in that study cited miscarriage as one of a specific, one of their specific concerns when taking antidepressants during pregnancy and actually discontinued their antidepressants because they were worried about miscarriage.So these concerns are having direct impacts on individuals and their behaviour and, you know, their potential management of their depression and anxiety.Speaker A00:06:33.190 - 00:06:44.230So, yeah, I think it's important to balance these risks against the mental health risks for the woman who's taking or needing antidepressants. And I think, as you point out, that was demonstrated beautifully in that qualitative research as well.Speaker B00:06:44.310 - 00:06:45.030Definitely.Speaker A00:06:45.670 - 00:06:59.990I wanted to sort of just draw back to how we can use these results in practice, really.And I wonder what your thoughts are about how clinicians and women should use these findings to inform their decisions around using antidepressants in pregnancy.Speaker B00:07:00.950 - 00:08:34.090Absolutely, yeah. So while I'm hoping that these results, as a non clinician myself, I'm hoping that these results can be informative for decision making.This isn't the only piece of evidence out there and it shouldn't be considered as the kind of gold standard, because it isn't.We utilize a lot of methods and comparators, we use large data, we've thought carefully about all of the things that might be driving these effects and discuss them at length. But it's not the only piece of the puzzle.I'm hoping that these results can help to kind of illuminate what the truth might be and the factors that might be influencing our perception of the results.So understanding data, understanding methods that will make us kind of rightly critical and cautious and understanding of what these types of studies in general mean, and also the fact that we've tried to kind of get at this baseline risk where we can report these proportions in both prescribed and non prescribed pregnancies should really allow for easy access to what these results mean. Rather than kind of speaking generally about relative increases, we can speak objectively about proportions in these data in these patients.Speaker A00:08:35.130 - 00:09:09.040Yeah, and absolutely, as you mentioned, it's part of the picture in terms of the decision making process that doctors and women...

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 practitionersAvailable at: https://doi.org/10.3399/BJGP.2024.0833There 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.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.810Hello 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 B00:01:05.530 - 00:02:37.470So, 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 account, that again, changes your trends and your current figures.Speaker A00:02:38.510 - 00:02:46.830And in this paper you used a few different ways to calculate the number of gps. But just talk us through briefly the data sets that you used here to look at that.Speaker B00:02:46.990 - 00:03:45.590So we use the nhs, England's GP workforce data set that provides both national figures and practice level figures.So we use the national figures to look at the overall trends and then we looked at practice level figures to disaggregate and look at sort of the range, the median and the 95th and 5th percentile of patients per GP across practices in England. We also used the number of patients registered at jail practice to get our total number of patients, your denominator from the nhs.But we also compared this to Office of National Statistics, Office for national statistics ONS figures of mid year population estimates between 2017 and 2023 to again compare how you know what your population is changes the number of patients per GP or gps per capita. You can calculate it both ways and.Speaker A00:03:45.590 - 00:03:57.920I think just setting that out shows us why this is actually a really complicated area.So there's lots of different ways to define a GP and how they're working, but there's also lots of different sources you can look to to count a GP as well.Speaker B00:03:58.880 - 00:04:21.140Correct. And, you know, there's, there's nuance to this.And the risk is that if we don't consistently count them and report them in the same way, then you end up having different figures and people end up speaking at cross purposes and people can pick and choose which figures to use depending on what's more convenient in terms of the story that one wants to tell.Speaker A00:04:21.940 - 00:04:27.980Fair enough. Okay, so let's move on to what you found. So what were the numbers of total GPS if we were just doing a.Speaker B00:04:27.980 - 00:06:05.730Headcount between 2015 and 2024? So we took quarterly data over that period and we saw that there was.If you take headcount, so this is the absolute best case scenario, you take headcount and you include trainees, there was an 18% increase, so it rose from 41,193 to 48,758. That's raw number of GPs in NHS general practice. A separate question is GP's not in NHS general practice? But that's a different study, not this one.But then if you consider working hours so full time equivalent and you exclude GP trainees on the basis that they are not equivalent to a GP because they might not be delivering the same amount of care, foundation union doctors may not choose to specialise in general practice. So therefore, arguably shouldn't be included in the overall numbers. So full time equivalent and no trainee, what we found is actually a 5% reduction.So from 29,364 down to 27,966 between September 2015 and September 2024.If then you take into account population growth and using NHS registered patients rather than ONS figures, what we actually see is only a 6% rise in the headcount plus trainees. So that's 6% rise versus an 18% rise. That's once you've taken population growth into account.And when you actually take in population growth into account and consider true sort of working figures, which are full time equivalents without trainees, there's actually a 5% reduction in the number of GPS per capita. Yeah.Speaker A00:06:05.730 - 00:06:16.030And I also wanted to touch about the range of patient to GP ratios across the country, because what you found here suggested that there's actually a big range between these ratios across England as well.Speaker B00:06:16.510 - 00:06:55.010Yeah, that's right. So that was the next part of the analysis where we looked at practice level data.So what we saw is that between the period of September 15 and September 2024, the gap, or the difference between, say, the 5% practice of the least number of patients per GP and the 95th percentile, practices with the greatest number of patients per GP, that increased. So there's a big difference.So, and that's principally driven because the gap has increased, because those at higher end, those with more patients per capita, has increased that faster rate than those with less patients per capita.Speaker A00:06:55.490 - 00:07:01.250And what does that mean on the ground for these practices in terms of the ratio of patients to GPs?Speaker B00:07:01.970 - 00:07:49.290Well, the thing is, I guess we don't. We don't know the reason for this. So our study didn't examine the reasons for this. You might speculate there might be a variety of reasons.So practices may have employment shortages, they might be in areas that are struggling to recruit, they may have made active decisions not to recruit for financial reasons, they may have less gps, but actually may have many other additional roles.So other direct patient care roles, pharmacists, social prescribers, physios and so on, and therefore compensating their GP shortage, the relative GP shortage with other roles. But again, that was beyond the study and that's only, you know, what we can infer based on what's going on in just now.Speaker A00:07:49.930 - 00:08:10.920Yeah, and I think this study is really interesting because it's kind of based around how all these things are defined. And you point out in the paper that depending on how you define a GP, there could have been a rise of 18% of GP

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 studyAvailable at: https://doi.org/10.3399/BJGP.2024.0677The 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 A00:00:00.320 - 00:00:53.350Hello 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 B00:00:53.720 - 00:02:09.550Yeah. 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 A00:02:10.030 - 00:02:50.390Yeah. So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of receptionists.And as you mentioned, you took quite an interesting and varied approach here.So you did the ethnographic work that you mentioned, but you also did interviews with patients and staff and practices and the ethnographic work was really interesting. So you were actually sitting in eight different practices and observing what receptionists were doing.But I want to really focus on what you found here and I think the first thing to talk about is that the receptionists had a really different and varied role between those different practices and even within the practice itself. So talk us through that.Speaker B00:02:51.170 - 00:03:43.630Yeah.So speaking to a couple of receptionists who'd been in the role sort of a longer time, they were reflecting in their interviews about how the role itself, from their point of view, having been in it for such a long period of time, has changed. Previously they would do sort of fewer and more repetitive type jobs, but now it's just so much more varied.That's just one person within their role over a period of time.But then we were noticing that receptionists within one practice and between the different practices, we went into what was conceptualised as a receptionist.What the receptionist role looks like was very different and it was impacted by whether the practices had specific administrators, so people like reception clerks or IT officers, the number of different receptionists that were available and working on. On shift, and also the confidence and competence of each specific receptionist themselves.Speaker A00:03:43.950 - 00:04:02.830Yeah, it's interesting you talk about experience and I think that probably a lot of people who work in general practice might reflect on that.But talk us through what you found in terms of the differing experience that receptionists had, just in terms of how comfortable they felt with the varied role or changing role. Really.Speaker B00:04:03.310 - 00:04:55.060Yeah. So some staff who were sort of newer to the role, it's all. They're sort of known. We had some cases of.Because there was sort of a lack of training and support around some of these newer bits of the role in a formal sense. There was a lot of support happening from receptionist to receptionists and sort of learning on the job types of things.But it would mean that for newer members of staff who are learning on the job, they might be shown something by one person and then shown how to do the same task, but in a slightly different way by another person.And then for that new member of staff, that could be quite disorientating, quite nerve wracking, because then they didn't really know which was the right way to do it and which way they should be doing it. So, yeah, because of that lack of more formalized training there for newer members of staff, that was. That was quite tricky.Speaker A00:04:55.300 - 00:05:24.370Yeah, fair enough. So maybe a nod there to the need for more formal training rather than the ad hoc kind of training that people get on the job, potentially.Yeah, fair enough.And I think that one thing that a lot of people working in general practice and probably patients really can empathize with is how people get through to practices, you know, by phone or by E consults. It's quite complicated, actually, at the moment. And you talk about this in terms of demand management in this work.How did this impact on the receptionists?Speaker B00:05:24.850 - 00:06:20.400Yeah, so it's, as you say, it's not just them seeing people as they walk in face to face and letters and telephones, which was, you know, how things happen traditionally, but all of these different online ways to access practice, which is great for patients, but, you know, can be a bit of a nightmare to manage. So you've got things like email, you've got online triage tools, you've got practice websites, you've got different apps.And then, you know, during the pandemic, the NHS app came in, so sometimes practices were running, you know, a more local app with the NHS app with the practice website and all of these things. So there were lots of modalities for patients to contact the practice via, which in. In some ways can be a good thing. You know, it's.It's just the reception staff were saying, it's.It's not actually reducing demand, it's just the same level split across multiple different things, which adds complexity to what they're having to manage through those different channels.Speaker A00:06:20.640 - 00:06:25.120And did they have clear pathways on how to manage that? How did they deal with that?Speaker B00:06:25.360 - 00:07:06.750Yeah, so, I mean, every practice was kind of worked it through differently.So they might have some members of staff who would monitor emails, they might have some members of staff who would look at econsults or something like that. So they split it up that way. And other people might say they split it up by the individual person was responsible for the different way in.Others split it up by a bit more of a rota to try and make it a bit more varied for staff so they didn't get bored doing the same thing every day.So they might have a morning being responsible for whatever E consults were coming in, and then the afternoon they might be doing something else and someone else would take over that role. So, yeah, each practice was sort of.Speaker A00:07:06.750 -...