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
Social prescribing
Connecting patients to non-clinical services in their local community to support their health and wellbeing is the role of social prescribers, who are usually accessed by a referral from a GP. Since 2022, every primary care network has been required to provide access to social prescribing (SP), and in 2023 the NHS Long Term Workforce Plan included a commitment to fund 9000 link workers by 2036–2037. This database study aimed to describe SP activity in England from 2009–2023.1 Prior to the national rollout in 2019, SP was sparsely used. Since then, the rise in SP has been rapid, and in 2023 there was an estimated 544 consultations related to SP per practice. From 2019–2023, the authors estimate 9.4 million GP consultations involved discussions about SP, with 5.5 million consultations leading to a referral. SP also appears to be doing a reasonably good job in reaching underserved populations, with 42% of SP patients from the top five most deprived deciles and 22% from minority ethnic backgrounds.
“… 42% of SP [social prescribing] patients [are] from the top five most deprived deciles and 22% from minority ethnic backgrounds.”
Asking about drug allergies
Conversation analysis (CA) is a research methodology that focuses not just onwords but intonation, timing, inflections, and emphasis. One area of particular use in health care is understanding the impact of how we ask questions to patients. In this study in England and Sweden, researchers applied CA to 57 consultations aiming to explore how clinicians asked about drug allergies — specifically penicillin allergy — and understand how this influenced patient responses.2 They found that the timing and wording of drug allergy questions impacts patient understanding and certainty of response, in particular whether the question was asked in the information gathering or treatment planning phase of the conversation: ‘Asking about allergies generically during information-gathering may lead patients to misunderstand the topic of the question. However, when asked later with the possibility of antibiotic treatment already on the table, drug allergy questions are less likely to be misunderstood.’ As a zero-cost intervention to potentially reduce harm associated with prescribing errors, thinking about when and how we ask questions is an easy win.
Commercial primary care pricing
Health care that is free at the point of use underpins our work in the NHS. The global sum, the amount of money a practice is paid for a year of care to an individual patient, is currently £121.79 per patient. In the US, however, primary care physicians are reimbursed for care by Medicare/ Medicaid programmes at a set rate or are paid a negotiated rate by commercial insurance providers. This study aimed to examine commercial physician prices from large insurance companies for primary care consultations.3 For new patient consultations the mean price was $145.20, with a lower rate of $101.60 for established patients. Larger practices or those under corporate ownership were able to negotiate higher prices per consultation. Primary care physicians, despite working in their area of expertise, obtained lower prices than specialists in internal medicine, paediatrics, and other specialties. Practices in lower-income areas were paid less than those in wealthier areas.
HbA1c variability
Haemoglobin A1c (HbA1c) levels reflect average blood glucose levels over a period of 8–12 weeks and is the standard test in the UK for monitoring diabetes mellitus. As with any biological measurement, values are subject to within-individual variation, which the authors of this UK study break down into two parts: analytical variation (imprecision in measuring process); and biological variations (influenced by predictable factors such as time of day or season but mainly by chance).4 Including over half a million patients with at least four measures of HbA1c, they aimed to assess within-individual variation to inform decision making in clinical practice. They found that HbA1c variation was higher in patients with diabetes and pre-diabetes than those without and was higher in patients with more severe disease, that is, a higher median HbA1c. This may introduce additional complexity and uncertainty into management recommendations for these patients.
References
1. Bu F, Burton A, Launders N, et al. National rollout of social prescribing in England’s primary care system: a longitudinal observational study using Clinical Practice Research Datalink data. Lancet Public Health 2025; 10(11): e903–e911.
2. Barnes RK, Lindström A. Asking about drug allergies: managing antimicrobial medicines related risks in primary care in England and Sweden. Patient Educ Couns 2025; 140: 109287.
3. Wang Y, Meiselbach M, Wang X, et al. Commercial prices for primary care physician office visits. J Gen Intern Med 2025; DOI: 10.1007/s11606-025-09798-8.
4. Gough A, Marshall T, Sitch A. Within individual variation of HbA1c measurements in primary care: a retrospective cohort study. PLoS One 2025; 20(10): e0333438.
Featured photo by Centre for Ageing Better on Unsplash.
