With the potential dismantling of the GP partnership model and the drive for a multiprofessional workforce in primary care, is this the right time to look at shared leadership as a facilitator of positive change?
"The function of a diagnosis is more than to guide treatment planning. It often provides emotional relief for patients, even if the diagnosis is dire. As Susan put it, “I keep hoping that some doctor will tell me exactly what this ‘skin
The title, ‘What is a doctor?’, neatly articulates a contemporary query. As the multidisciplinary team (MDT) becomes increasingly complex with additional moving parts, the role of the doctor becomes ever more difficult to describe. The memory of the ‘family doctor’ is fading.
In clinic last week, a patient called me by my first name – this was the first time I have experienced this in primary care, and for some reason I found it quite jarring. ...there seems to be very little evidence on
Merope Mills’ description of the death of Martha, her 13 year old daughter, is a raw and harrowing account of the mistakes doctors made that led to Martha’s deterioration and ultimately her death. Nada Khan evaluates the concept of a Martha’s rule,
As part of a Student Selected Component focussing on frailty in primary care, supervised by Paul McNamara, Scott Wylie had the chance to learn directly from GPs and attending local frailty services. As part of the project, he also carried out an
What can patients who recall their experience of death during a cardiac arrest tell us about consciousness? Armando Henrique Norman explores
I had progressed from A-Levels into becoming a GP... without pausing for breath - or allowing time for the aspect of my professional practice I enjoyed the most; teaching. But not clinical or consultation skills; instead, anatomy.
As our NHS shows increasing signs of its own sickness, many are calling for more funds, staffing, and technology. These may be necessary but are certainly not sufficient. What else of importance are we missing?
"I was very impressed by all those professionals working hard to make a difference for other people. I recognised myself in so many of the patient experiences described." – Elke Hausmann provides an overview of the 'Long COVID: what needs to happen
Why do people consult medial opinion? Alex Burrell looks at a classic paper on the the 5 triggers to seeking medical advice.
Tim Sanders views the “rewiggling” of the Swindale Beck in the Lake District as a metaphor for a need to nurture and cherish core aspects of generalism, continuity and relationship-based care within the role of the GP
So, how can GPs help their patients in facing transformative decisions? The advice, helpfully explained by Richard Armitage, is to reframe the decision-making process with which we approach them.
General Practice, then, shares the values of both the dinner date and the mobile phone, and this is reflected in the way patients consult differently depending on context, preferring ease of access for simple acute problems and continuity of care for complex
"I firstly prompted GPT-4 to “Answer the following as if you were a GP trainee in the UK.” I then asked [it] each of the 45 text-only questions ...from the RCGP AKT practice paper"
The Independent Pregnancy Loss Review, published in July 2023, offers recommendations to improve care for women and their families experiencing pregnancy loss, and includes specific advice for primary care.
So, doctors... are learning to be afraid of uncertainty, ordering ever more tests and prescribing more and more, to try – often in vain – to be sure... But where does that leave Patient Earth?
Variety is a selling point for the profession itself (challenging and interesting) and for the resources needed to do it well (GPs are ‘best’ placed to do many great things but need time and money invested). Andrew Papanikitas introduces this month's Life
"School is integral to the long-term wellbeing and aspirations of children, so it is a cause for significant concern that school absence has increased markedly since the COVID-19 pandemic ... "
All of us in the NHS want to help people, we wouldn’t be here otherwise. But, and I only use diabetes as an example, how much of our work now inadvertently keeps a proportion of our patient’s sick?
In the summer before COVID-19 it the UK, I read three works of fiction (one after another) that changed my perspective on the world and our place in it: The Wall, The World according to Anna, and The Ministry for Future
Richard Armitage argues that, in three well-defined contexts, clinical decision-making should be delegated to AI systems either today or in the very near future.
'Caring for carers is everyone’s business, though general practitioners (and we use our words wisely) are perhaps best placed to identify and support carers -more so than other health professionals.' argue Helen Walker and Clare Gerada
If we want to avoid missing significant diagnoses, and tigers, we cannot examine every symptom or blade of grass exhaustively, but we can cultivate an openness to the sort of cognitive dissonance that points to unrecognised danger. Ben Hoban explains
Introducing a temporary weight loss fix using GLP-1 agonists without consideration of the wider implications and long-term plan is quite frankly, an absurdly short-sighted idea, argues Elizabeth Dapre
GPs allow patients to make harmful choices – thereby affording primacy to autonomy at the expense of beneficence – when that harm accrues only to the individual making such choices. But if your future self is a different person, does that mean
We often consider the malfunctioning of the health service to be someone else’s fault; the government's, the GPs', the receptionist's … but if we reflect on how our expectations, as a society, have changed over time, perhaps we might find ourselves complicit.
'When reading the spread of articles in this issue it struck me that we need diversity to be better clinicians, colleagues, and citizens.' Andrew Papanikitas reflects this month's Life and Times articles, discussing gender, diversity, narrative and queer bioethics.
In general practice we can discuss end of life and treatment escalations decisions with patients before they become very unwell, and this is where the ReSPECT process could potentially give a space for a meaningful patient-centred discussion about preferences at the end
In an attempt to improve physical health outcomes in this group, patients registered at their GP practice as having a severe metal illness are eligible to undergo an annual health check in a primary care setting. Richard Armitage discusses recent progress.
The recent release of “Queen Charlotte”, the Bridgerton spin-off series on Netflix, has reignited interest in the illness of King George III. Whilst the series is described as ‘fiction inspired by fact,’ the story of King George leads into the wider
Professor Joanne Reeve applies a new book on Mindlines and finds hope for UK primary healthcare
So what we need is the invention of a ‘new category’ of General Practitioner. David Mummery sets out his manifesto for the future general practitioner. Discussion welcome!
The wolves in the forest that frighten human beings are now at last being accurately named: poverty, homelessness, hunger, unemployment, domestic abuse, adverse childhood experiences. Humans like sheep have a basic need to feel safe. They can’t function well until that need
Hannah Barnes has written a detailed account of what happened at the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS). Margaret McCartney reflects on the risk that healthcare organisations run when worries from staff translate into organisational defensiveness.
A recent BBC Panorama ‘expose’ of private ADHD clinics suggests that some online providers are over-diagnosing ADHD following inadequate clinical assessments. Patients are increasingly turning to private providers both out of pocket and through right-to--choose arrangements, and ultimately, GPs may be asked
"I predict that, by June 2025, all GPs will be using some form of LLM-powered co-pilot in their day-to-day practice ... Used (and regulated) correctly, these tools will enhance patient care, improve GP working conditions, and relieve pressures on general practice in
"Morale in general practice has never been lower, and I can say that having been a GP for 37 years. In all this adversity and negative press, the care has carried on regardless, even allowing pockets of brilliance to shine through. We
Primary care systems can clearly be described as networks of people and things, ideas, processes, relationships and technologies. It is patently clear that we have a duty open the black boxes of our primary care systems, lest ignorance of how they work
What are the personal and human factors that most motivate and anchor our best healthcare? What best nourishes and sustains both patients and healthcarers to endure together life’s most difficult challenges? This book answers such questions with luminous and engaging clarity.