Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Cancer diagnosis in PWLD
Improving care for patients with a learning disability (PWLD) is a priority for the NHS. A key area to address in achieving this is cancer, the second most common cause of death in this patient group accounting for 15.7% of avoidable deaths. A potential reason for avoidable deaths is diagnostic delay: PWLD experience difficulties in recognising cancer symptoms, communicating their experiences, and navigating the healthcare system. This primary care database study found that PWLD were significantly more likely to have their cancer diagnosed via emergency presentation and significantly less likely to be diagnosed via the urgent suspected cancer referral pathway.1 They were more likely to be diagnosed with advanced stage cancer at presentation and had almost four times the odds of dying within 30 days after their cancer diagnosis. These are stark figures that need urgent attention.
“… this is a timely reminder that musculoskeletal medicine is still an important area to maintain knowledge and skills in as a GP.”
MMR vaccine rates and residential mobility
Coverage for the first MMR (MMR1) vaccination from 12–24 months of age in the UK is currently around 89%, with North East London having the lowest coverage rate at around 80%. Both are well below the recommended 95% to achieve herd immunity, likely contributing to rising rates of measles in recent years. This study in North East London used primary care records to explore possible associations between residential mobility (moving house in the first 24 months of life) and low MMR1 uptake.2 In a sample of 150 949 children, 84.8% had received MMR1 between 12 and 24 months of age. Children with two (75.5%; odds ratio [OR] 0.44) or three or more GP-recorded addresses (68.7%; OR 0.31) were less likely to have received MMR1 by 24 months of age than those with one GP-recorded address (87.6%) when adjusted for individual, household, and area-level covariates. This offers useful insight on a group to prioritise to improve vaccination coverage.
Musculoskeletal consultations
Throughout GP training we had a multitude of presentations from various specialties, each telling us that problems with their organ or system made up about 20% of the workload in primary care. Had they heard each other’s talks they would have seen this was mathematically impossible, but it seemed to be the figure of choice. This study in the Netherlands can help for one speciality at least: the authors used a primary care database covering 2.5 million patients to explore the proportion of consultations for musculoskeletal disorders (MSDs).3 From 2017–2023, MSDs were the leading contributor to consultations in Dutch general practice at 11.3%–12.6%, with lower limb the most frequently occurring site followed by upper limb and back. MSDs mostly occurred in those aged ≥45 years. With first-contact physios now being a regular fixture in many practices, this is a timely reminder that musculoskeletal medicine is still an important area to maintain knowledge and skills in as a GP.
Predicting registrar performance
Summative exams in GP training determine whether registrars are fit for unsupervised practice. Failing these exams can lead to extended training time and individualised support, with significant emotional and financial stress for registrars and logistical challenges for the training school. This Australian study explored whether registrars at risk of failing these exams could be identified early by doing a formative initial assessment on training programme commencement.4 From 2011–2015, GP registrars undertook a pre-general practice assessment — a written exam and an OSCE — before commencing their community-based clinical general practice rotations to assess their skills and identify individual training needs. Both assessments were significantly predictive of performance in subsequent summative assessments, with small to moderate effect sizes. While not wanting to overburden registrars, this could be a useful tool to offer proactive tailored support and is worth considering.
References
1. Wiering B, Abel GA, Farmer L, et al. Inequalities in cancer diagnostic outcomes for patients with a learning disability: a retrospective cohort study in England. BMJ Oncol 2026; 5(1): e001104.
2. Firman N, North L, Marszalek M, et al. Residential mobility and receipt of measles, mumps and rubella vaccination: analysis of linked primary care electronic health records in a London region. Int J Popul Data Sci 2026; 11(1): 2963.
3. Krastman P, Heijneman K, Bosman A, et al. Insights into the proportion of consultations for musculoskeletal disorders in Dutch general practice: a register-based retrospective cohort study. BMC Prim Care 2026; 27(1): 239.
4. Fielding A, Patsan I, Holliday E, et al. Predicting general practice trainee summative fellowship exam performance using commencement-of-training formative assessments: a retrospective cohort study. BMC Med Educ 2026; DOI: 10.1186/s12909-026-09530-y.
Featured photo by IGOR LOLATTO on Unsplash.
