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BACKGROUND: The British Journal of General Practice (BJGP) is the leading primary care journal in the world. By impact factor, it ranks 24th of all medical journals. However, despite major changes in the journal since its inception in 1954, there have been no published readership surveys since a limited report in 1969. AIM: To canvass members of the Midland Faculty and to add to the debate about the future of the BJGP. METHOD: A postal questionnaire was sent to a random sample of 299 members, fellows and associates of the Midland Faculty asking for their views about the BJGP. RESULTS: Two hundred replies were received (a response rate of 67%). The median year of qualification of responders was 1981, and 32 (16%) held academic posts. Ninety-nine (49%) disagreed with the present format of the BJGP, which compared poorly with the British Medical Journal (BMJ) in simple rank order of importance. Readership was equal to that of the BMJ (93% reading it within 28 days of arrival), but fewer people read it within a week of receiving it. The most popular sections were the editorials, original articles and letters; least popular were the book reviews and the pull-out magazine, Connection. All sections were rated excellent to average. Readers wished for an expansion of the BJGP to include clinical reviews, medical politics and humorous pieces. Most responders felt that Connection should remain separate. There was dissatisfaction with the delay between submission and publication of original articles, particularly among the academic general practitioners (GPs). Academics and fundholders did not differ from other readers in their views of the content or style of the BJGP. Half of the responders stated that the BJGP should be self-financing and should be open to more advertising. Responders' free comments largely related to improving the style of articles and expanding the BJGP. CONCLUSION: There is a view that the present BJGP is not relevant to the non-academic GP. This is probably due to style rather than content. Simple comparisons with a weekly multi-disciplinary journal may not be valid. The style could be updated to improve retention of information and to highlight areas of particular relevance. Readers are satisfied with the core content of the BJGP but want it to expand to include humour, clinical reviews and medical politics, for example. There is no evidence that the BJGP is more appealing to the academic GP. This study supports an expanded BJGP with an improved style.

General Practitioner (GP) out-of-hours (OOH) co-operatives provide urgent primary care across the Republic of Ireland, but national workload trends and hospital referral patterns are poorly described. To quantify OOH activity (2013-2022), examine for changes in OOH service utilisation over time , and describe emergency department (ED) referral rates. Retrospective observational study using aggregated electronic medical record (EMR) data from eight large GP OOH co-operatives across the Republic of Ireland, 2013-2022. Annual measures included total consultations and consultation type (triage-nurse versus GP consultation; teleconsultation, treatment-centre visit, home visit). Subsets provided age mix and ED referral data. Descriptive analyses were contextualised with nationally available open data and prior literature. Across 2013-2022, participating OOH services recorded approximately 0.9 million consultations annually, with an overall 26% rise in consultations over the 10 year period. Two major inflection points were observed: introduction of free GP care for under-6s (2015) was followed by a 17% rise in consultations (2014-2016), whereas COVID-19 coincided with an 18% fall in consultation volume and fewer face-to-face visits (2020-2022). ED referral rates remained broadly stable at~13% throughout. OOH GP co-operatives provide substantial, adaptive capacity- managing the vast majority of patients within primary care. This study supports the view that OOH co-operatives act as a buffer for EDs and a pressure-release valve for daytime general practice. Routinely collected EMR data can track OOH activity over time and should inform workforce and service planning.

The Pharmacy First Scheme, introduced on 31 January 2024 as part of NHS England's Primary Care Recovery Plan, allows community pharmacies to treat seven common minor ailments. Pharmacy First aimed to ease pressures on primary care and improve accessibility as over 80% of people live within 20-minute walking distance of a community pharmacy. This study aimed to evaluate the effect of Pharmacy First on General Practice appointments, particularly within a 2-week or same-day target, and how this varies regionally, by deprivation and urbanity. This retrospective descriptive and interrupted time-series analyses used Stata to analyse an open NHS Digital dataset of appointments (January 2022 - November 2024). Deprivation and urbanity measures are derived from the 2022 Health Foundation report. Key measures included time from booking to appointment, and healthcare professional type. The results found a significant pre-intervention increase in appointments with limited significant post-intervention trends. Statistically significant decreases occurred in same-day GP appointments in both the most and least deprived 20% of Integrated Care Boards (ICBs) and the least urban 20%. The data showed strong seasonal variation, peaking in autumn, and falling in summer. Limited post-intervention data points and pronounced seasonality limit certainty on Pharmacy First's early impact. These results align with NHS Wales Choose Pharmacy interim reports, perhaps indicating that consistently high appointment demand means available appointments remain filled. Future research could explore appointment reasons and patient demographics. Decreases in same-day GP appointment numbers for less urban areas and the most and least deprived areas could be a focus for promotion.

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Chronic breathlessness poses significant burden for individuals and healthcare systems. Effective symptom-directed approaches, such as breathing and relaxation techniques, require medical optimisation of the underlying long-term condition causing breathlessness. We previously identified nine, predominantly cardiorespiratory, long-term conditions contributing to the greatest burden of breathlessness in primary care. Develop checklists to support primary care in delivering optimal, evidence-based management of conditions causing chronic breathlessness. Synthesis of national guidance and stakeholder workshops, using a co-design approach. Desktop review of national guidance relating to management of each condition was synthesised as the basis for the checklists. Virtual workshops and interviews were conducted to further adapt checklist content with stakeholders (primary care staff, clinical specialists and representatives from national speciality groups). Workshops were recorded and facilitated by a qualitative researcher with clinical experience. Insights from workshop data were incorporated to produce draft checklists for verification by workshop participants. Checklist contents were refined and agreed in consultation with national specialist groups. Electronic patient record templates were developed to operationalise the checklists. Twenty-two national guidelines were reviewed and synthesised into the checklist drafts. Six virtual workshops and nine individual interviews were conducted with 30 key stakeholders (five GP, four nurses, six physiotherapists, three pharmacists, three dieticians, nine physicians). Participants directed the checklist format to include safety netting, key diagnostic checks and optimal management. Short pragmatic evidence-based checklists were developed for use in primary care to support primary care clinicians in managing the main conditions contributing to chronic breathlessness.

International medical graduates (IMGs) currently account for 41% of the UK medical workforce. IMGs in training posts face challenges in progression including a significant 'award gap' (previously differential attainment) in postgraduate training compared to UK medical graduates. General practice (GP) is disproportionately impacted by these issues as over 50% of GP trainees are IMGs. Previous studies focusing on educational interventions to reduce the award gap have failed to improve training outcomes. To identify literature addressing the factors underlying the award gap. The scoping review will follow the process outlined in the Joanna Briggs Institute (JBI) guidance. Input was sought from a specialist librarian, patient and public contributors, stakeholders with lived experience of working as an IMG and experts in the research field. Studies eligible for inclusion will be those reporting educational outcomes (concept) for IMGs (participants) undertaking UK GP training (context). Searches will be conducted in Medline, EMBASE, SCOPUS and PsycINFO for articles reporting educational outcomes for IMGs in UK GP training. A two-step screening process will be employed to identify eligible articles. Analysis will involve basic descriptive statistics reporting the number and type of evidence sources. Reporting of the data will be in line with the PRISMA-ScR checklist and will include visual representations of findings including graphs and figures developed with stakeholders and PPI group members. By exploring the literature which reports the factors underlying the award gap in GP training we will identify areas for further research.

In Australia, general practitioners (GPs) act as gatekeepers of the healthcare system, so consultation data are essential for policy and resource allocation. However, recent national evidence linking consultation frequency with sociodemographic factors, morbidity and medication use is limited. To quantify GP consultation frequencyamong 'regular' patients' attending Australian general practices, and explore associated sociodemographic and clinical factors. Cross-sectional study with adult 'regular' patients (18+years; 3+visits in two consecutive years) who attended an Australian general practice in 2021 (MedicineInsight database). We performed multilevel zero-truncated negative binominal models to explore the association between the number of consultations with patient's sociodemographic characteristics, morbidity and medications. In 2021, 1 302 932 (76%) people were 'regular' attenders to their practice, contributing 10 806 418 consultations. The median number of consultations was 6 (IQR:3,11), with variations by sex, age group and the presence of health conditions. The model showed that being female, older, living in more disadvantaged areas, having chronic, recurrent, or acute conditions, and being prescribed medications were all associated with higher consultation rates, after adjusting for other covariates. The highest relative consultation rates were observed among people aged 75+years (IRR 2.54, 95% CI 2.48;2.61) and those with a diagnosis of chronic pain (IRR 1.82, 95% CI 1.79;1.85) or depression/anxiety (IRR 1.67, 95% CI 1.65;1.69). GP consultation frequency was strongly influenced by age, sex, disadvantage and morbidity, with comparatively lower attendance among younger men despite recorded health conditions. These findings highlight potential missed opportunities for monitoring, prevention and early management.

Polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing, however challenges exist in general practice. To test the implementation of a co-designed multidisciplinary SMR intervention (MODIFY) for this high-risk group. A non-randomised pre-post feasibility study was conducted across five general practices in England. The multidisciplinary intervention comprised five components including patient and health care professional (HCP) preparation. Patients aged ≥75 with moderate-to-severe frailty (eFI >0.25) and ≥5 medications were identified and invited to participate.Primary outcomes were recruitment, retention, and completion of outcome measures. Secondary outcomes included medication-related outcomes, healthcare utilisation, adverse drug reactions, and acceptability to patients and HCPs based on qualitative interviews. Of 479 patients invited, 48 were recruited (10% rate); 47 received the intervention, 43 completed three-month follow-up (92% retention). Medication changes occurred in 87% of participants; 72% had at least one medication stopped and 26% had a dose reduced. The mean number of medications decreased slightly by 0.27 (SD:1.44) without significant change in clinical and patient-reported outcomes (including function, frailty status, treatment burden) and no reported adverse events. Qualitative interviews with 10 patients, 1 carer, and 8 HCPs, indicated high acceptability and perceived value, and suggested improvements.Economic data was well completed. SMRs cost £28.50 per patient. Participants' reported quality of life improved slightly over three months. The MODIFY intervention is feasible and acceptable for deprescribing in primary and support progression to a definitive trial.

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Although inequalities in social determinants of health (SDOH) are linked to poor health, they are often overlooked in healthcare. Primary care networks (PCNs) are an example of neighbourhood-level multidisciplinary teams (MDTs), established in part to address SDOH at locality. Further research is needed to understand how UK primary care health care practitioners (HCPs) understand and manage patient SDOH through these teams. To explore how UK primary care HCPs view SDOH and how they perceive working in PCN MDTs influences their ability to address them. A qualitative study undertaken in general practice in the UK. 25 primary care HCPs (GPs, GP trainees, nurses, pharmacists, care coordinators and social prescribers) were recruited via purposive sampling (males=10, females=15). One-to-one semi-structured interviews were conducted between April 2023-May 2024. Thematic analysis revealed three key findings. First, participants described how primary care is uniquely positioned to address SDOH through community proximity and integrated MDT services. Second, they expressed helplessness to change SDOH, citing barriers outside their clinical sphere of influence. Finally, they raised concerns over tensions between rising expectations of primary care and insufficient structural resources, including staffing, estates and training, to tackle complex SDOH issues. MDTs were widely viewed by HCPs to improve the ability of general practice to address SDOH in community-based services due to the unique remit of multidisciplinary roles, and the extra time that some roles are allocated for patient consultation. However, further resources are crucial for these teams to achieve meaningful impact.

The COVID-19 pandemic induced several significant changes within general practice related to visiting frequency, types of consultations, and clinical staff managing patient contacts. It is relevant to study if these changes related to patient consultations continue after COVID-19 restrictions have ended. To describe and discuss changes in the services offered by general practice to their patients during and after the COVID-19 pandemic. A cohort study including 19.906 patients from 7 Danish GP clinics followed for three full 12 months periods before (February 2019 - January 2020), during (April 2020 - March 2021), and after the COVID-19 pandemic (April 2022 - March 2023). Visiting frequency, consultation type (face-to-face, email, phone), and contact persons (GP or their clinical staff, eg, nurses) were compared during the three observation years. The number of annual clinical contacts per patient (6.5 contacts/year) as well as the fraction of consultations being on the phone (32.3%) are back to pre-COVID-19 levels, whereas the increased fraction of contacts by email (20.7%) and increased fraction of encounters managed by the non-GP clinical staff (79.3%) observed during the pandemic has remained also after the pandemic period. The general practice that patients meet today is different from before the COVID-19 pandemic. Face-to-face consultations are fewer, e-mail consultations have become more frequent, and a greater proportion of patient encounters are managed by non-GP clinical staff such as nurses. Studies on patient satisfaction related to these changes are needed.

Our previous review highlighted that limited knowledge and understanding of Binge Eating Disorder (BED) and Bulimia Nervosa (BN) amongst primary care professionals may negatively impact their identification and management. Whilst UK guidelines provide some guidance on identification and management, it is currently unknown what, if anything, is actively implemented in practice. To map current practices used in primary care in the UK to identify and manage BED/BN. An online mixed-method survey focused on primary care settings. A combination of convenience and purposive sampling was used for recruitment. The sample comprised healthcare professionals (HCPs) working in primary care and individuals with lived experience (LE) of BED/BN aged 16+years. Data was analysed using descriptive statistics and thematic analysis. Of 598 respondents, 347 (58%) were HCPs, 251 (42%) were individuals with LE. Up to 74.3% of HCPs reported not actively screening for BED/BN. SCOFF questionnaire was reported to be the most used standardised tool for identifying potential BED/BN. HCPs reported referral as the main way of managing BED/BN, while LE participants reported using self-help as the main way of managing BED and referral for BN. Differences in practices between BED/BN are reported among HCPs and LE, such as identification practices, as are differences in HCP and LE perspectives, such as ways to manage BED. There are considerable variations in primary care practice for identifying and managing BED/BN. Providing clear guidelines for both HCPs and patients should be prioritised to ensure consistent care delivery.

Polypsychopharmacy has been associated with increased risks of adverse drug reactions, metabolic syndrome, and higher healthcare utilization. Although its prevalence is well-documented in secondary and tertiary care, data from primary care settings remain scarce. This study investigated trends in polypsychopharmacy, associated factors, and prescribing patterns in Dutch primary care from 2012-2021. We conducted a cross-sectional analysis of a primary care database containing medical records from approximately 500 000 adult patients across 100 practices. Polypsychopharmacy was defined as concomitant use of two different psychotropic medication classes for≥90 days (chronic). Point prevalence was measured on July 1st of each year from 2012 to 2021. We performed a multivariate analyses (using 2021 data) to identify factors associated with polypsychopharmacy, including demographic characteristics, mental and physical comorbidities, analgesic use, and healthcare utilization. The prevalence of polypsychopharmacy increased from 7.6 (95% CI: 7.3-8.0) to 12.6 (95% CI: 12.3-13.1) per 1,000 patients between 2012-2021 (annual increase: 0.49 per 1,000; 95% CI: 0.40-0.57). The most common combinations were antidepressant-antipsychotic (473 per 100,000), antidepressant-anxiolytic (387 per 100,000), and antidepressant-hypnotics/sedatives (251 per 100,000). Factors associated with polypsychopharmacy included older age, female sex, multiple psychiatric diagnoses, use of analgesics, and high healthcare utilization. Polypsychopharmacy in Dutch primary care increased considerably over the past decade, increasing demands on general practice. Although certain regimens may be clinically justified, the upward trend underscores the need for further research into prescribing appropriateness, strategies to optimize psychotropic use, and the role of non-pharmacological treatments in primary care.

Underuse of emollients and topical corticosteroids (TCS) contributes to uncontrolled atopic eczema, but variations between countries remain unclear. To compare the actual use of emollient and TCS use in childhood eczema in the UK and The Netherlands (NL) and examine treatment adherence in relation to guidelines. A secondary analysis of data from the Rotterdam Eczema cohort study (n=367) (NL), the BATHE trial (n=482) (UK) and BEE trial (n=520) (UK). Frequency of emollient and TCS use were compared at baseline and after 12-16 weeks of follow-up by age, sex and disease severity. Treatment adherence was defined as: 1 a) not using an emollient at all, 1b) not using an emollient when a TCS was used, 2) not using a TCS when eczema is mild or worse. Overall undertreatment was defined as category 1 and 2 combined. In total, questionnaire data from 1312 children (aged 3 months-17 years) with mostly mild (26-37%) or moderate (45-48%) eczema were analysed. Not using an emollient was significantly more prevalent in NL at baseline (14%) and follow-up (19%) than in the UK (4% and 7.6%, respectively). Not using a TCS when eczema is mild or worse differed significantly (P<0.05) between countries. The overall undertreatment rate was high and did not differ significantly between countries at baseline (UK 52.0%-NL 48.2%) and follow-up (UK 45.0%-NL 49.8%). Undertreatment with emollients and TCS are common and a reminder for clinicians to explain treatment rationale and check treatment adherence. Differences in treatment practices between countries warrant further exploration.

Social media is a pervasive part of young peoples' lives and may influence their mental health. Primary care is often the first point of care when seeking help for mental health problems. However, little is known about how young adults with mental health problems experience and perceive primary care support for managing social media. To explore young adults' views on help-seeking for social media use in primary care in relation to mental health problems. Qualitative interview study with 28 young adults aged 18-25 with self-reported mental health problems across England. Semi-structured interviews were analysed thematically to identify barriers and facilitators to help-seeking. Themes were organised using the Theory of Planned Behaviour - attitudes, social norms and perceived behavioural control. Barriers for help-seeking included attitudes that social media was a secondary issue and low expectations of meaningful support; perceived negative attitudes and limited understanding of social media by primary care clinicians, communities and families; and constrained ability to seek help due to limited consultation time and uncertainty around how to seek help. Facilitators included clinicians offering practical strategies, raising the topic non-judgmentally, receiving training to better understand young people's digital lives, longer appointment times, and clearer information about support in primary care for social media-related concerns. Young adults with mental health concerns face multiple barriers to discussing social media in primary care, shaped by attitudes and structural challenges. Addressing these through clinician training, communication, and service adaptations may enhance engagement and support.

General practitioners (GPs) play a crucial role in managing urgent medical cases, yet data on the nature and urgency of such cases in primary care are limited. Existing research focuses mainly on emergency departments (EDs) and out-of-hours services, underestimating acute care delivered by GPs. To develop and psychometrically test an instrument designed to comprehensively assess urgent medical cases in general practice. Cross-sectional survey in German practices, with GPs documenting urgent cases during a self-selected workday. The ACUTE-GP instrument was developed, piloted, and finally tested in a cross-sectional survey. The final tool comprises ten items capturing physical, psychological, administrative, and therapeutic aspects. Psychometric properties were examined using principal component analysis to assess the factorial structure, and reliability was evaluated using the Kuder-Richardson coefficient (KR-20). Fifty-eight GPs assessed 572 consultations. Of these, 342 (60%) were managed entirely within the practice, with 60% classified as urgent or emergencies. Emergency consultations showed the highest mean number of aspects (mean = 4.6), followed by non-urgent (3.9) and urgent ones (3.2). The instrument demonstrated satisfactory internal consistency (KR-20 = 0.621) and content validity. GPs provide substantial acute care, challenging the perception that urgent cases necessarily require ED management. Further validation of the ACUTE-GP instrument in diverse healthcare settings and its integration into routine practice are recommended.

Older people from ethnic minority communities are disproportionately affected by the risks of polypharmacy due to higher levels of multiple long-term conditions, unequal access to care, and communication barriers. Medicine optimisation is a key approach to improving prescribing and outcomes, but how it works for older people from ethnic minority communities in primary care remains poorly understood. To explore how, why, and under what circumstances medicine optimisation works or does not work for older people from ethnic minority communities with polypharmacy, from the perspective of primary care practitioners. A realist evaluation using semi-structured realist interviews with primary care practitioners in England and Wales. We conducted seventeen interviews with GPs, clinical pharmacists, community pharmacists, and practice nurses. We analysed the data using a realist approach to refine and extend an initial programme theory developed through a prior realist review. Seventeen primary care practitioners participated, representing diverse professional roles, ethnic backgrounds, and levels of experience. Analysis identified 18 context-mechanism-outcome configurations, organised into five areas: practitioner strategies, patient beliefs and stigma, communication and language support, informal carer involvement, and system constraints (especially time pressure and remote consultations). Medicine optimisation worked well when practitioners showed respect, adapted communication to cultural and language contexts, and negotiated family involvement. Barriers included stigma, deference to authority, reliance on herbal beliefs, language limitations, and informal carer burden. Improving medicine optimisation for older people from ethnic minority communities requires relationship-based, context-sensitive care. These findings offer theory-based insights for UK primary care.

General practitioners (GPs) working in areas of high deprivation in Scotland formed the 'Deep End' group in 2009 in response to the well-documented inverse care law (ICL). To understand the views and experiences of key stakeholders about responses to the ICL in general practice in Scotland over the past 20 years, and the impact of the Scottish Deep End Project. Qualitative study with key primary care stakeholders (n=17) in Scotland, UK. Semi-structured interviews. Five main themes were identified, reflecting participants' experiences of working in deprived areas and their views on the role of the Deep End. These themes describe how existing measures fall short of addressing the ICL, how intersecting disadvantage complicates service responses, and how sustainability, professional identity, and collective voice shape efforts to improve care in disadvantaged communities. A key recommendation was greater investment in primary care generally, but with graded additional resources for more deprived areas depending on need (a "proportionate universalism" approach). Despite widening health inequalities, and the long-standing evidence of the ICL in general practice in deprived areas, there is a paucity of enduring policies and interventions to tackle the ICL in Scotland. The Scottish Deep End group has created a distinctive platform for general practitioners to collectively challenge the inverse care law. Practitioner-led networks can play an essential role in addressing health inequalities, supporting professionals, and informing policy.