BJGP Interviews

Today, we’re speaking to Dr Eliza Hutchinson, a dermatology registrar and academic clinical fellow based at the Centre for Applied Excellence in Skin and Allergy Research at the University of Bristol.Title of paper: Eczema, acne, and psoriasis in people with skin of colour: a qualitative UK-based studyAvailable at: https://doi.org/10.3399/BJGP.2025.0720This study is the first, to the authors’ knowledge, to explore the experiences of living with an inflammatory dermatosis specifically in people with skin of colour. We generated eight themes important to participants: delayed or missed diagnosis; preferences regarding healthcare professionals; lack of online information and social media use; misunderstandings in cultural communities; concerns about treatment and lack of research; complementary medicine use; experiences and impact of dyspigmentation; and challenges with structural racism. These findings offer insight into the complex experiences and challenges faced by UK adults with skin of colour living with eczema, acne, and psoriasis. Our practical points for primary care clinicians are a step towards facilitating mutual understanding and improving care for people with skin of colour.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 - 00:00:53.150Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the BJGP. In today's episode, we're speaking to Dr. Eliza Hutchinson.Eliza is a dermatology registrar and an academic clinical fellow and she's based at the Centre for Applied Excellence in Skin and Skin Allergy Research at the University of Bristol. We're here to talk about the paper she's just published in the bjgp and the paper is titled Eczema Acne and Psoriasis in People with Skin of Color.A Qualitative UK based Study. So, Eliza, it's lovely to meet you and thanks again for joining us to talk about this paper.But before we talk about the paper itself, I'm just wondering what made you specifically interested in researching skin conditions in skin of color?Speaker B00:00:53.550 - 00:01:34.700Yeah, thank you so much for having me.So I think people with skin of color have been and still are massively underrepresented in kind of medical curricula, learning resources, clinical trials. And I certainly remember when I was at medical school, I don't think I had any teaching on diverse skin tones at all.And so it was as I sort of learned more dermatology, I just became very aware that they are so underrepresented. And I think earlier work in this area, I really tried to improve education for medical students and healthcare professionals around skin of color.That was kind of my starting point.And then I realised actually there's very little, if anything actually on the experiences of people with skin of colour, which is kind of what led me to this project.Speaker A00:01:35.820 - 00:01:38.380And you work in dermatology, is that right?Speaker B00:01:38.460 - 00:01:42.300Yes, yes, I'm a dermatology registrar based in the Bristol Bath area.Speaker A00:01:42.540 - 00:02:06.890Great. So it's wonderful to have your expertise in this especially.And we may get into this sort of about sort of your perspective from secondary care as well, looking back into general practice as well. But this paper focuses on eczema, acne and psoriasis and these are conditions that we see a lot as gps.So why did you feel that this was an important area to look at for people with skin of colour?Speaker B00:02:07.290 - 00:02:41.470Yes, I mean, as you said, we know that skin conditions are super common.They make up over 14% of GP consultations and eczema, acne and psoriasis are some of the most common inflammatory skin conditions we see and we know that they have a significant burden on everyone that experiences them.But I think particularly in people with skin of colour, we already know that these people experience kind of increasing things like Dispigmentation, so skin tone getting lighter or darker from their skin condition. And yeah, I think I just wanted to focus on some of the more common conditions that are seen kind of day to day in primary care.Speaker A00:02:42.110 - 00:02:54.890And this was a qualitative study and you emphasized that you really wanted to understand the experiences of people here. So talk us through a bit what you did. You spoke to people who had these conditions and had skin of colour?Speaker B00:02:55.050 - 00:03:26.060Yes. So we recruited using online methods for a couple of reasons, but really wanted to get kind of diverse range of experiences from across the uk.So we started off with an online survey and that was open to people of all skin tones. And we have written this up as a separate paper which should be out hopefully in the next few months.But based on these responses, we then kind of purposefully recruited people with skin of color to take part in an online one to one interview. And so we spoke to 20 different people with skin of colour as part of this.Speaker A00:03:26.460 - 00:03:40.300And I think one of the really interesting things that came out and is running as a strong theme through the paper is that skin conditions can present really differently in skin of colour. Can you explain a bit about what that means in practice as well?Speaker B00:03:40.700 - 00:04:49.210Yeah. So we know that skin conditions can look and behave very differently in people with skin of colour compared to white skin.So for example, eczema is typically in a kind of flexural distribution in people with white skin, so like in the elbow creases behind the knees.But in people with skin of colour it might be more likely to be on the extensor surfaces, it might be in a sort of discoid type pattern, so kind of well defined round patches or sort of a follicular pattern is another one we see. So if you look at medical textbooks and what we're taught at medical school, we just don't see pictures of these presentations.And I think another big thing is obviously redness is much less obvious in skin of colour. So that's typically what we would associate with skin inflammation is redness and it is much less obvious.And instead in darker skin tones it might look kind of purpley. Brownie might not be as obvious. And certainly in the interviews we found that patients were aware of this as well.So they were looking at their own skin and not picking up that it was kind of actively inflamed. They didn't know what it was and they'd go and see a GP or another healthcare professional in primary care and they also wouldn't know.And then it's just kind of leading to Delayed diagnosis, misdiagnoses.Speaker A00:04:50.140 - 00:05:16.780Yeah, And I think that's certainly something. So the people you spoke to described these delays in diagnosis and also this uncertainty from clinicians.And I do wonder if that is reflected in what we learn and what the wider public understand is what inflammation might look like as well. So I wonder what really stood out to you from these experiences.So how did people and clinicians sort of navigate those delays and uncertainty as well?Speaker B00:05:17.320 - 00:05:44.760What was quite shocking was in terms of the misdiagnosis a lot of the time, infection and infestation.So, for example, scabies was a big one that people were misdiagnosed with, and that in some circumstances did lead to kind of stigmatisation, psychological distress, embarrassment, and then people were more afraid to seek help. Further delays in diagnosis. Yeah, I think that was the thing that struck me the most in terms of this problem.Speaker A00:05:45.240 - 00:06:00.040And you've mentioned this, you talked about dyspigmentation, and that came through as well very strongly in the interviews. And I think that's probably a problem that's specific to skin of color as well.And can you talk through why that came up as such an important issue for patients in this study?Speaker B00:06:00.760 - 00:06:46.890Yeah, of course. So I think we already know that dyspigmentation.So skin tone usually getting darker, but sometimes lighter as a result of skin inflammation, we know that it is more common in darker skin tones just because they've got more melanin there to start with. But the thing that struck me in these interviews was just the profound impact that this can have on patients.So embarrassment, isolation, body dysmorphia. There's a lot of misunderstanding as well, kind of within certain communities about what causes it.And some people experience negative comments from within their own community, from friends and family, which really exacerbated that kind of psychosocial impact even more. And obviously, skin tone is massively tied into kind of identity, and the impact on people's wellbeing was just. Yeah, it was huge.Speaker A00:06:47.690 - 00:06:58.490And coming from a general practice perspective, it sometimes feels like the treatment options for dyspigmentation are really...

Today, we’re speaking to Dr Charlotte Morris, a GP and academic based at the University of Manchester.Title of paper: Experiences of primary care for people with dementia from socioeconomically disadvantaged areas: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2025.0407Existing national guidance recommends primary care-led dementia health care, but little is known about the experience of this for people living in socioeconomically deprived areas. This study highlights that people with dementia, and their carers, in socioeconomically disadvantaged areas want to maintain identity and understand their decline. Support from healthcare services often diminishes over time, with difficulties accessing and navigating healthcare systems when needed. There was uncertainty about primary care’s role in dementia health care. Clearer communication and proactive support from primary care may improve experiences for these patients.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.320 - 00:00:32.850Hello and welcome to BJ GP Interviews. I'm Ewan Lawson and I'm the editor of the BJ gp. Thanks for listening to the podcast today. In this episode, we are speaking to Charlotte Morris.Charlotte is a GP and doctoral research fellow at the University of Manchester and we have recently published her paper, Experiences of Primary Care for People with Dementia from Socioeconomically Disadvantaged Areas A Qualitative Study.So, Charlotte, first of all, what I'd like to ask you is how did you come to focus on people with dementia in deprived areas specifically, and what surprised you most in the interviews?Speaker B00:00:33.170 - 00:02:03.470Thanks, Ewan. Thanks so much to you and the BJGP for inviting me to do the podcast and publishing the paper.So, I guess my interest in people with dementia started when I finished my foundation training and I did a clinical fellowship year in London where I worked on a ward with people with dementia specifically. And at that time I wanted to be a care of the elderly doctor.But I was struck by how many people kept coming in and out of hospital with dementia regularly. We'd spend ages trying to get them home. They go home for maybe one or two days and then sadly come back on this cycle.And I think in reality, a lot of those people would probably have been better at home, even if that shortened their lives very sadly.And it made me realise I wanted to work in the community with people with dementia, trying to improve healthcare in terms of advanced care planning and kind of planning for progression. So that's where my interest in dementia came in.And I work in a practice in a relatively deprived area of Greater Manchester, and I always had an interest in health equity for kind of various reasons and health equity in terms of various lenses as well.So when I was designing my PhD project, I decided to kind of focus on both aspects, so health inequalities in terms of deprivation and primary care for people with dementia.Speaker A00:02:03.870 - 00:02:08.270I mean, I know we're going to touch another on some other stuff, but. Yeah. What surprised you most in the interviews?Speaker B00:02:09.390 - 00:02:47.530I think in terms of what surprised me most in the interviews, I think I was actually struck by how much people wanted more health care from their primary care teams. It's not like they felt they were getting the best care or they were really kind of thrilled with what they were getting in lot of times.But they were actually very trusting of their primary care teams and they really, really wanted more of that health care, which kind of struck me, really.And I actually found it kind of quite touching and humbling, as a practicing GP myself, to know that we were really valued and that the care that we provide, people tend to want more of it rather than less.Speaker A00:02:47.610 - 00:03:21.390Yeah, so that leads in nicely, because I wanted to ask you about one of the themes in your paper, which was the kind of proactive continuity.And several of your participants described your wanting their GP to take the initiative, you know, to call them, to know them, so just to anchor their sense of self while the dementia progresses. There was a one man who had Alzheimer's who named it Ali. Was a kind of a. Was a striking example. You know, what, what kind of sense?What does that tell us about what primary care needs to be doing? I mean, you mentioned there about how much it was appreciated, but what kind of. What do you think they can do more of?Speaker B00:03:22.000 - 00:04:42.080Yeah, I think that kind of theme of proactive continuity splits into two, really. So I think the idea of being proactive is really important and people wanted their GPs not only to know them, but to actively contact them.Sorry, I mean, not just their gps, actually their whole primary care team recognising that we all work together in our practices as well as that proactivity.They wanted somebody who knew them, knew their family, knew their kind of history, knew the kind of outside of their life, rather than just their medical condition or their dementia. And that was really striking and came through kind of very strongly from most people who were interviewed, really.And I interviewed people with dementia and carers and from both sides. That idea of being known by their primary care team did come through very strongly.And I think for me as the interviewer and for me as a practicing gp, I also really like that side.You know, knowing our patients, knowing that person, and being there for the kind of entire journey of a diagnosis to dementia all the way through to that progressing. It's a real privilege and I think it's something really precious for us as, as primary care teams, that continuity.Speaker A00:04:42.240 - 00:05:02.930There was a bit of a gap. There wasn't. There's this kind of, oh, you know, there's potential gap in that.And you mentioned this in the paper about the falling away support, that sometimes participants went to the memory clinic, then they were discharged, and then they felt a little bit like they, you know, they weren't picked up necessarily. I wondered if you could tell us a little bit more how that showed up in your interviews.Speaker B00:05:03.570 - 00:06:27.830Yeah, yeah, for sure. So I guess everybody, everyone did describe a kind of different journey.And I don't want to just generalize, but the sentiment or the feeling I got from most people was that there was concern around a possible diagnosis, a kind of flurry of activity around when the diagnosis was made, referral to memory clinic, lots of calls.Somebody described a mind boggling array of things being offered around that time of diagnosis and then after that things seeming to kind of fall away. So somebody described the specialist dropped them and they were seen by memory clinic, started on medication and then just left back to the gp.So that idea of kind of there being a flurry of activity and then things gradually dropping away and that being a paradox because actually people felt that their needs generally increased as time went on. So that was very interesting really. And I've also done.It's kind of not a published paper yet and it's still being worked up, but I've done some interviews with primary care providers as well and that seemed to kind of come through as well from them and that there is a flurry of activity around one point around diagnosis. But then as time goes on do things do seem to kind of drop off and change. So it's perhaps felt from both sides as well.Speaker A00:06:27.830 - 00:07:03.200Yeah. Let's talk a little bit about when sometimes it doesn't happen so much or people who knew the system.And there was definitely an interesting rather novel finding that came out and I guess it's something we might be aware of, but I haven't seen too many papers that have highlighted it, that if there was someone in the family who knew the system, that was often perceived as crucial and it sort of implies a system rewards social capital or maybe it's just very specific to medical systems. But I wondered if you could, you know, how worried should we be about that? What can primary care do to address it or to flatten those kind of.Those kind of flatten it out. If there is a. If it is an inequality.Speaker B00:07:04.000 - 00:08:54.200Yeah, I think a great question and I also thought this was one of the most interesting themes to come out of the paper actually.So just to kind of describe it, a lot of people described how if they had a family member or a friend who knew a little bit about the healthcare system, so if they'd worked in research or if they'd worked in social care, they would be called upon to kind of navigate this complexity of the system and it kind of came through that they would know who to contact, know how much to push, know what strings to pull to get somebody seen. And that insider knowledge, how we termed it, seemed crucial in kind of getting things done.And, and that was described in detail by one...

Today, we’re speaking to 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 AdultsAvailable at: https://doi.org/10.3399/BJGP.2025.0169There 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 A00:00:00.880 - 00:00:49.180Hello 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 B00:00:49.660 - 00:02:24.450Oh, 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 A00:02:24.530 - 00:02:39.170And 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 briefly who was included in the study and what were you looking at specifically?Speaker B00:02:40.380 - 00:04:04.090So looking at patients where calprotectin was being used for diagnostic purposes, so calprotectin is also, as you probably know, well established for monitoring patients with existing ibd, monitoring response to treatment for flares, et cetera. We were just looking at patients where it was being used for diagnostic purposes. So any patients with existing IBD were excluded from the study.And then, yes, as you said, anyone who had a calprotectin within a six month period back in 2021, who then subsequently within a one year period had a colonoscopy performed at Imperial, which is the local referral centre, that were included in the study. And we only looked at adult patients. We had a cohort of older adults which we used to cut 50 and above, and a younger cohort below that.We didn't look at pediatric cases, that was how we selected patients.And then we reviewed available electronic documentation to ascertain the diagnosis of the patient, looking at clinic betters etc, as well as looking at other tests that patients may have had performed when their symptoms are being evaluated. Fit testing, for example. We also looked at CRP and haemoglobin.By collecting that data, we were able to ascertain the diagnostic performance of chiroprotectin in the two respective cohorts. And also in comparison with some of the other clinical tests that I mentioned.Speaker A00:04:04.710 - 00:04:21.670Yeah.And as you point out, because these tests might be used in quite a varied fashion depending on patient age or presentation, I suppose it's important to kind of work out what the diagnostic capabilities of them are. And I think that's what this study really aimed to achieve. Really.Speaker B00:04:22.630 - 00:05:04.510Yes, exactly.So we were trying to look at how calprotectin performed in the older age group compared to the younger age group, and also looking at how its performance relative to fit testing in those two cohorts. We looked at the performance of calprotectin, the differentiating between inflammatory bowel disease and non organic GI pathology.And we also looked at its ability to differentiate between organic GI pathology more generally. So inflammatory bowel disease, colorectal cancer and other significant GI diagnoses and non organic pathology.Those two questions, which I think are important questions when considering patients presenting with GI symptoms in primary care.Speaker A00:05:05.710 - 00:05:14.190And just talk us through what you found here. And I think the results were really striking in terms of things were different according to age and maybe not surprisingly. But talk us through that.Speaker B00:05:15.550 - 00:07:19.810I think the key findings are firstly that calprotectin remains a sensitive test in both groups.So sensitivity when using a cutoff of 50 micrograms per gram, which is the nice advised cutoff for considering a positive calprotectin Test suggested by nice.There are other, you know, there is other data in the literature about altering the cutoff which calprotectin is considered positive, but 50 is the cut, you know, is one of the cut offs we looked at and is what is suggested by, in the NICE guidelines using that cutoff, you get sensitivities of over 90% for diagnosing IBD from non organic GI pathology in both age groups. What you see in the older age group is a significantly lower positive predictive value. So positive predictive value of only about 12%.And using that cutoff in the patients who had, again using that cutoff of 50 in the small number of patients who did have colorectal cancer, if you then did try to push up the threshold at which calprotectin is considered positive, as many guidelines do suggest, you would then start to, to miss cases of colorectal cancer, which just highlights one of the important messages of the paper and that is clearly documented in the NICE guidelines that calprotectin shouldn't be used as a biomarker for cancer and if cancer is suspected, patients should be referred on the appropriate urgently suspected cancer pathway. We also found that calprotectin did perform better than fit tests for diagnosing ibd.But, but there's also potentially some future work to be done in patients who may have had FIT testing because of concern over potential colorectal cancer.But in patients where FIT is negative, calprotectin may then have a role as a good rule out test in that group where you've already ruled out suspected cancer.So that's maybe an area for future work and maybe it just helps to allow us to think about how we may have a more kind of joined up pathway for evaluating patients with lower GI symptoms in primary care.Speaker A00:07:20.930 - 00:07:30.290And I know some local guidelines might suggest faecal calprotectin alongside FIT in younger age groups. What are your thoughts about this based on the results of this work?Speaker B00:07:30.930 - 00:08:26.550I think it depends what symptoms the patient's presenting with.I think if patients present with symptoms that according to the NICE guideline that's potentially suggestive of colorectal cancer, then obviously they should be evaluated, you know, appropriately with FIT testing or, you know, onward referral. And I think, you know, I think calprotectin clearly has a role in younger patients for differentiating between non organic GI diseases and ibd.I think in older patients it's, you...

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 ExperiencesAvailable at: https://doi.org/10.3399/BJGP.2024.0781Menopause 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.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 - 00:01:12.020Hello 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 B00:01:13.620 - 00:02:57.750Essentially, 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 really was. Was underlying that. That gap.Speaker A00:02:57.910 - 00:03:31.880Yeah.And I guess, as you said, based on that previous research, you really wanted to get this deeper understanding of what was shaping menopause and HRT management and prescribing patterns.And I think just to sort of move on to what you found, really, I thought that one of the initial things that really stood out to me was the women that you spoke to talked about the menopause and how menopause care has changed over generations and how that impacts how women seek help. And I wonder if you could just start by talking us through this and what the women you spoke to told you.Speaker C00:03:31.880 - 00:05:16.160It's a really interesting study because obviously the time is right to be talking about menopause. It's going through this phenomenal change.And a lot of the women that we spoke to reflected on how that change had impacted their lives and how different their experiences might have been from the. The previous generation. A lot of women talked about when it came to menopause, they wanted to know about their mum and their mum's experiences.That's often a first port of call.But actually what a lot, particularly of the black and Asian women were telling us was that they were experiencing a different life to their own mum, that there were different pressures now, particularly in terms of being career driven, juggling intergenerational family and feeling the pressure of modern life, whilst also trying to manage their own experiences.So the current generation really are quite unique in as far as they've got a whole load of challenges and a whole load of stress that perhaps generations before them haven't had.So when they're having conversations in the family, it's a little bit mismatched because Mum might be saying, well, that's not what my experience was like.But the younger generation is perhaps thinking, well, yeah, because mom didn't, perhaps didn't work full time or, you know, didn't exist in the Western world in the same way as we do now.So it, I think that comes to play for a lot of women, particularly around career development and the fact that so many women in their middle lives now are still working full time and juggling family responsibilities, and that presents an additional stress to then also prioritizing your own health. And that's something that women found difficult to do amongst all those pressures as well, I think, was something they told us.Speaker A00:05:16.810 - 00:05:25.210Yeah. And in some communities it seemed as though there's still quite a lot of stigma around discussing the menopause openly. What did they talk about here?Speaker C00:05:25.610 - 00:06:46.450Yeah, I think obviously menopause is a hot topic and it's being spoken about in lots of ways, but that doesn't mean it's not still taboo for lots of women.Many of the women that we spoke to still hadn't had those conversations within their families because it was still something that was considered perhaps shameful and that they were expected to just deal with. Some of the black women spoke about the stoicism and being expected to be brave and have a high pain threshold.And some of the Asian women spoke about families and fertility and the patriarchy and the way that things are perceived and said that for them, actually having those menopause conversations within their homes was not as easy as it might be perceived. And so having that peer support from within the family, within the communities hasn't developed as strongly yet.It is starting to come through so that women are enabling each other with their own experiences. And where that does happen, it's really powerful.I think the women told us that, you know, peer support is really valuable, family support is really valuable, but it is still a topic that women feel stigmatized and embarrassed sometimes to talk about, particularly if it's not something that they've been open to discussing as they've been brought up through their, through their families.Speaker A00:06:47.180 - 00:07:11.340Yeah, it's really interesting because when we think about maybe the kind of information sources that women might have, so family or community or peer support would really play into that.And I wonder if they talked about that tension from how menopause or seeking help for the menopause might be perceived in the community and how that affected their help seeking behavior to their gps at all.Speaker B00:07:11.900 - 00:09:02.730So I think, I think that's exactly right.Women spoke about how not only how menopause was, as Claire said, talked about or not talked about in their own communities, but actually how any information around menopause in this country, how often they felt they didn't feel represented.And actually if they didn't feel represented, that might be through what was said or an image of what a woman going through menopause might look like or on an advertisement, actually. They just didn't feel a connection there. And therefore they felt, well, this isn't about me.And that was a barrier really for them not going forward to get help.But really interestingly, lots of women spoke about the fact that actually when they'd got to a stage when they felt that they did need help, some of them considered how they might be in sometimes racially stereotyped during that consultation.That was something that for me as a researcher, I thought, crikey, the fact that women had actually...

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 EnglandAvailable at: https://doi.org/10.3399/BJGP.2025.0065General 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.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:01:00.730Hello 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 B00:01:01.510 - 00:02:25.330Yeah, 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 A00:02:26.200 - 00:02:55.660Great.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 certainly don't seem to go a day without a patient asking me about whether they can get a weight loss injection. But what did gps think about navigating these patient requests when they. When they get them?Speaker C00:02:56.140 - 00:03:56.260Yeah. So at kind of the moment we were conducting interviews, that was definitely a real source of sort of frustration and difficulty.There were quite a few patients presenting, asking for GLP1s, the majority of whom were ineligible often, or would only be eligible through kind of this longer, more drawn out process of accessing specialist care, which in many of the regions just did not exist or was going to take kind of years and years. So it was not necessarily an amazing option.This kind of left the gps we spoke to in quite an uncomfortable position where they kind of had to play the role of gatekeeper, really manage those expectations and potentially kind of have that compromising sort of interaction with their patients. So certainly the gps that we spoke to had some frustrations associated with that.Speaker A00:03:56.820 - 00:04:03.620Yeah, absolutely. And I suppose it's a little bit about how to manage those requests. So did the gps talk about that at all?Speaker C00:04:04.100 - 00:04:31.440Yeah, there were some different strategies that we heard about. I would say the primary one was just around identifying other options that would be available.That was more difficult in some cases where patients had already exhausted those options and were feeling quite frustrated.One of the other strategies that we heard about was testing patients for type 2 diabetes to try to identify whether maybe there was another avenue that they could kind of come in through.Speaker A00:04:31.840 - 00:04:47.040And did they talk at all about private prescribing or. We might come on to this a bit later. But did any of the gps talk about suggesting or dealing with patient requests for private prescriptions?Because I think that's quite a big industry and a growing industry at the moment as well.Speaker C00:04:47.360 - 00:05:42.850Yes, certainly our sample were very much aware of this going on and it had been kind of entering the remit of their practice, specifically kind of asking for prescriptions to be carried over into NHS care, which most of the time the answer was a pretty concrete and clear no on.So that could also be quite disappointing, particularly for patients who had come in through other international health systems who are then like, oh, I thought I would surely be able to get this on the nhs. And, yeah, a lot of the services didn't have, like, a great answer or kind of protocol to responding to those requests for private prescription.So there was also kind of the frustration of okay.This is taking up quite a lot of our time, quite a lot of our effort that could be put towards other things, especially at a time when we're so overstretched.Speaker A00:05:43.810 - 00:06:08.040And I think that leads on to the next thing I wanted to talk about.And I think that, as you say, one of the big concerns for GPs, especially given the increasing effort to provide GLP1 agonists to a wider community population, is how we're going to fit this in alongside all the other things that we're doing. So what else did the GP say about this and about the different resource limitations in general practice?Speaker B00:06:08.760 - 00:06:09.320Yeah.Speaker C00:06:09.400 - 00:07:15.450So I think many had an awareness that in kind of an ideal world, this made a lot of sense to be carrying out in primary care.A GP has that kind of connection, ideally to their patients, and is able to see kind of the broader context of where and how they live, who they are as an individual. But within that, there was an awareness that that was going to be exceedingly difficult given the resource limitations of the time.So a few of the gps we spoke to were essentially just like, we don't know how this is going to happen. This needs to stay in secondary care. It's just not kind of a viable model.Others were really worried that some of the components that should be integral to GLP1 delivery, like wraparound care, behavioral and psychological support, were certainly not going to be easy to provide within primary care. And there was a real discomfort of this is just simply not how the medications are or should be used.Speaker A00:07:16.570 - 00:07:48.870Yeah, I guess that goes back to How Current Tier 3 weight management services are provided or were provided, perhaps, in the nhs.And the fact that you're right, there's a bit of a wraparound system around it, and certainly GLP1 agonists would only have typically been prescribed in those services alongside, as you say, all of the different weight management services. So that's quite a hefty burden for a GP or practice to pick up.Judine, I don't know if you wanted to comment on that, given your background in weight management research as well.Speaker B00:07:49.590 - 00:09:14.320Yeah, I mean, I think, as Sabrina said, there's definitely concerns, but I think as well, there's definitely some very strong themes of these GLP1 drugs coming in as a very helpful tool as well, in a few different ways.So, for example, I think one of the gps that we spoke to voiced concerns about how sometimes it's quite tricky for people to navigate the best way to support themselves, to lose weight and to navigate

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 cancerAvailable at: https://doi.org/10.3399/BJGP.2025.0264This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.800 - 00:01:11.660Hello 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 B00:01:12.220 - 00:02:32.900So, 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 A00:02:34.710 - 00:02:44.710And 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 B00:02:45.350 - 00:05:50.240So 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 effects attributed to the chemotherapy itself, but then they're also having to tackle these hot flushes, insomnia, potentially arthralgia. Obviously the vaginal symptoms may be more medium to longer term impact.So you've got that group of women who are sort of thrust into menopausal symptoms very quickly and then you have the other group who perhaps have already gone through their menopause.So they're not necessarily getting those symptoms alongside chemotherapy, but, but then after that we are introducing letrozole, which by removing even that last little bit of oestrogen production in the system is giving them enhanced menopausal side effects yet again. So I think that's sort of psychologically a big thing for the patients to deal with as well.Whether they're sort of having all of that thrust upon them in one go or whether it's more gradual and they're almost waiting for it to occur. So I think for us, us there's a lot we've got to get through in our consultations.Obviously if it happens alongside chemotherapy, then we're seeing them regularly anyway. We've got our nurses to support them in the clinics too.But I think the challenge arises more when our ladies are moving on to their endocrine therapy and moving away from regular consultations in our clinics and having more contact again with primary care. They're wanting to get on with their lives. They're wanting to not be coming up to the hospital quite so often.And so that was a real focus of this article, wanting to reach out to primary care, but also perhaps non oncology based secondary or tertiary care practitioners.So maybe gynecologists or people that work very closely within menopausal clinics, not necessarily just within primary care and try and work out how can we support these ladies with symptoms that may take several months to declare themselves and may even be once they've been discharged to our stratified follow up programs, but not necessarily seeing us regularly in, in the clinic.Speaker A00:05:51.120 - 00:06:13.110And I think one thing that I'm always struck by, especially with Women going through the perimenopause and the menopause is that this is a busy time in women's lives. So they might be juggling younger children, a career, caring for, you know, older parents.So there's a lot going on in these women's lives that things like arthralgia, vasomotor symptoms are going to have a big impact on. Really?Speaker B00:06:13.910 - 00:07:33.180Absolutely. And I think it's really important that we let these ladies know that we're there to try and help and support them.We're not going to have a one size fits all approach for everybody. But also we do try and not paint a doom and gloom picture from the outset.Not all women suffer these symptoms to the same degree, of course, so it's sort of in making them aware that they could happen, but then arming all of those medical professionals that they may come into contact with, with the tools to work through and try and help and support. I think, you know, one, one thing that often vasomotor symptoms really impact, for instance, is sleep.And so, you know, insomnia can be a really big problem for our ladies.But actually, if you dig into it, you often find that it's because they're having their mainstay of their vasomotor symptoms in the night and they're being woken up by them and then they're struggling to get back to sleep.So, you know, yes, I agree it's a really challenging time, both in terms of what we might be contributing to in terms of their symptoms, but also them wanting to get on with their lives after this diagnosis.Speaker A00:07:33.820 - 00:07:52.690Yeah, fair enough. And you touch on the fact that systemic hormone replacement therapy is avoided in people with a history of breast cancer due to the increase in risk.But I wonder if you could talk us through some of the alternative options here that you mentioned in the paper. And let's start with the vasomotor symptoms because you just touched on that as well.Speaker B00:07:53.170 - 00:12:56.770So I suppose just to clarify, obviously the focus of this paper is in hormone receptor positive breast cancer because it is the majority subtype that we see in our women.It's not a blanket rule, but we are less concerned usually about the use of hormone replacement therapy in our ladies with the hormone negative subtypes. Of course, the primary care practitioners always very happy for you to contact us oncologists if you want to clarify anything there.But, you know, the focus of this article is about the hormone positive space.And so certainly within those early years after a diagnosis, our mainstay is trying to minimize that Circulating level of oestrogen as much as possible.Obviously that may be suppressing ovarian function with GnRH analogues but even on top of that, you know, if that were all that were required, then why do women, postmenopausal women develop hormone sensitive breast cancer? We know it's because of these, this production of estrogen elsewhere in the system.So then you've got your aromatase inhibitor medications, they're trying to eradicate even those small amounts.So it, it does, it's very counterintuitive for us to be able to support the use of even topical estrogen based treatments when we're in this sort of early stage after a diagnosis.That said, of course, and it's sort of outside the scope of this discussion, but of course, you know, we will consider the particular risk of that individual patient. We'll have...

Today, we’re speaking to Dr Jo Burgin, a GP and a researcher based at the University of Bristol.Title of paper: Mental health consultations during the perimenopausal age range – Are GPs and patients on the same page?: A qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2025.0069Mood changes are a recognised symptom of perimenopause, for which Hormone Replacement Therapy is considered a first line treatment. Recent studies have found mental health symptoms are overlooked in menopause care, which is mostly delivered in primary care. This study identifies some key barriers to identifying perimenopause in women presenting with mental health symptoms and suggests important changes clinicians could make to their consultations to address this.

Today, we’re speaking to Professor Helen Atherton. Helen is Professor of Primary Care Research based at the University of Southampton.Title of paper: What do patients want from access to UK general practice?Available at: https://doi.org/10.3399/BJGP.2024.0582Widely accepted as perpetuated by the media is that patients are unhappy with access to general practice and desire faster access to a general practitioner. This review sought to summarise the research evidence about reported patient wants from access to general practice. Patients wanted to easily make an appointment in a timely fashion, to have a positive relationship with the practice, to see a specific clinician and choose consultation modality according to individual circumstance. Communication and being kept informed about access throughout the process of making and having an appointment, was something patients wanted, and this could be addressed by general practice.Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:01:00.150Hello and welcome to BJGP 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 Professor Helen Atherton.Helen is professor of Primary Care Research based at the University of Southampton, and we've only just speaking to her recently on this podcast about the increasing digitalization of general practice. This time we're speaking to her about her recent paper here in the BJDP titled what Do Patients Want from Access to UK General Practice?So, hi, Helen.It's really nice to speak again about this area of research and I guess I just wanted to start by saying that access is such a loaded word and really, when it comes to general practice, it's part of a fairly negative media campaign against general practice. But it seems that this negative narrative just keeps getting pushed, despite lots of attempts to fix it.So I just wonder if you could reflect on that.Speaker B00:01:00.470 - 00:01:51.950Yeah, absolutely. So that the negative media coverage was one of the reasons that I wanted to do this review.So this review was a bit of a labour of love because I had a feeling from the work that I was doing on digital access and other research that actually the reality was probably quite different, what we were seeing in the headlines and having looked into it, although there's lots of research out there on patient experience and satisfaction, we have a national survey that looks at that. There wasn't anything about what patients actually want. And so that kind of.I thought, actually, wouldn't it be really interesting to find out from the evidence what they actually want and see if it does fit with the narrative we see in the papers and on social media. So, yes. So completely agree. And that was kind of where the idea came from, really.Speaker A00:01:52.420 - 00:02:08.180Yeah.And I just want to unpick what you really mean by access in this paper, because I think for some people it means, you know, just getting an appointment to see their GP within a day, but it can mean lots of different things to other people. So what did you conceptualize that as?Speaker B00:02:08.740 - 00:02:49.840Well, it was difficult.And you're right, there are lots of different definitions of access, and particularly in the research context, for us, we were interested in access to an appointment, so we were very focused on the processes that patient would go through in order to get the appointment, go to the appointment.And we did go back and forth several times with this review because it was so difficult to define and there will be other researchers who use different definition, but because we were so interested in a lot of the kind of media narrative. It just felt like the best fit to look at access to an appointment with a gp.Speaker A00:02:50.000 - 00:03:04.540So this paper was a systematic review and you looked at papers which explored different aspects of access. And I guess the big question here is, what did patients want in terms of access?I wonder if you could just give sort of a headline summary and then we can talk a bit more in depth about it.Speaker B00:03:04.780 - 00:03:56.070Sure. So what was interesting is I don't think their wants were particularly surprising or out of line with what general practice wants to deliver.That's the first thing to say. And it was things like wanting to choose a clinician that they've seen before, if they.If they've seen a clinician before, wanting to have choice around the skill mix. So which healthcare professional. They saw the consultation modality wanting to have a good relationship with the practice.They wanted ease of booking and relatively speedy access. But not. There wasn't any evidence that people all wanted to be seen on the same day, which is maybe how the media narrative goes.And there were also some things around wanting it to be easy to get to and having a nice waiting room. So really quite simple things as well.Speaker A00:03:56.230 - 00:04:19.350I think choice is a really interesting area to explore.So some people might not feel they have the right access if they get booked in, like you say with the gp, they don't know, or if they get booked in to see someone working in another clinical role in the practice.But I wonder what you thought about the implications, given the increasing lack of continuity of care and this widening multidisciplinary team in practice.Speaker B00:04:19.870 - 00:05:16.510Yeah. So it didn't escape our notice that a lot of what we were seeing was probably at odds with current policy around general practice.The fact that patients fully understand that continuity of care is important at times, and there's lots of evidence that that is the case. And general practice, as a rule, tends to encourage that, I would say. And then also with the skill mix at odds with the idea that you.You can kind of sub in other healthcare professionals as a way to tackle lack of capacity. Whereas I think patients are smarter than that and realise that sometimes it's appropriate, but other times it's not. Yeah.And then also with the digital as well.So, again, people wanting the choice, understanding that sometimes it's better to do things that way or more convenient, but not wanting to be forced down that route, which is kind of the way that we're going, really, in terms of policy for digital access.Speaker A00:05:16.990 - 00:05:24.830And. Yeah, talk us through that.What people thought about access in terms of the kind of consultation they got like a telephone or a face to face appointment.Speaker B00:05:24.830 - 00:06:12.650Yeah. So patients were happy to have those types of consultation.So when it came to use of remote consultations, patients were happy to do that where it met a need. So if they didn't want to come to the practice, they weren't able to.Perhaps if they had a sensory disability, lots of reasons why they wanted to do it, but wanting to have the choice about how that happened, which was interesting. So people would say they didn't want to have to travel to the practice because it wasn't convenient.This could be around work or childcare, or it might be that they had mobility issues, but there was generally a reason why they didn't want to be in the proximity of the general practice. And that's when remote consultations were what patients wanted.Speaker A00:06:13.450 - 00:06:35.840Yeah, fair enough.So it seems a lot of the time people just want a choice and I think it's interesting, particularly given the increase in a triage first approach in many practices.But there was something you mentioned in the article that I thought was quite interesting, which was about co production with patients to solve access problems. Just tell us what you think this should look like.Speaker B00:06:36.160 - 00:08:01.890So as well as doing this review, I'm involved in other research around access to general practice. And a big thing that we see happening is almost like a. Not a lack of communication, but a miscommunication between patients and practices.You know, not intentional, nobody's trying to confuse the other, but patients perhaps not really understanding the access systems in place, not understanding what is available to them. If they don't have a choice, why they don't have a choice.And so I think there's a lot of room for more kind of working together in terms of what that looks like. I think we have to be brave and ask patients what they want.This is a systematic review, so it looks at existing evidence and most of those studies were not focused on looking at just what patients wanted, they were looking at other things as well. I think if we were to ask...