Alex Burrell is a GP in Bristol.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Urgent care triage
In the UK, patients accessing urgent care via 111 will have primary triage conducted by a non-clinical operator using an algorithm. Around 50% of these patients are transferred to an urgent care provider and will subsequently undergo secondary triage by a clinician. This study in Northwest England aimed to compare primary and secondary triage outcomes for patients who attended an emergency department (ED) or were admitted in the 24-hour period following a call to 111.1 In the study period, 98 946 patients underwent primary and secondary triage. Of these, 20 745 (21.0%) attended ED or were admitted within 24 hours of secondary triage. Most of these patients (n = 17 517; 84.4%) either had their care completed in ED or were discharged from inpatient care within 24 hours, suggesting they had conditions more appropriate to being treated in primary/urgent care. Secondary triage had higher specificity and positive predictive value for ED attendance or admission, with primary triage having greater sensitivity reflecting risk aversion.
Pre-pregnancy care
Pregnancy-specific advice prior to conception is often opportunistic and in the context of other discussions: there is no standard pre-pregnancy care (PPC) GP appointment, although there is guidance on broad areas to cover. This database study in England aimed to better understand women’s PPC received in GP services in the year prior to pregnancy.2 Of the 14 326 women who became pregnant during the study period, only 7.6% had PPC recorded in the preceding 12 months: even for women with pre-existing conditions, only up to 14.9% of women received documented PPC. This is despite the fact that almost all (96.9%) pregnant women had some contact with GP services in the year prior to the start of pregnancy. As with any database study, some PPC advice may not have been documented or coded, but this work suggests we are missing opportunities for health promotion.
Heat islands
Extreme heat causes excess mortality, particularly in older adults. Due to climate change, this is likely to be of increasing concern nationally and internationally in the coming years. Urban areas are, on average, hotter than rural areas: this phenomenon is known as the urban heat island (UHI) effect and occurs for several reasons including building materials, human activities, and low soil moisture. This study focused on the UHI in Greater London, the region with the highest rates of heat-related mortality in the UK.3 Using advanced urban climate modelling, the authors aimed to estimate the mortality and years of life lost (YLL) to the UHI effect in Greater London in the summer of 2018, as well as the associated monetary social costs. They conclude that approximately half of the 785 heat-related deaths and the 9.8 thousand YLLs were due to the UHI effect, with monetised cost of attributable mortality approaching a billion GBP. It’s important to consider that UHIs may reduce deaths related to cold weather in winter, which are currently more frequent in the UK, but as the authors say, ‘summer urban heat needs to be taken seriously as an increasing risk to human health’.
E-scooters
City-dwellers in the UK will be aware of the introduction of e-scooter rental schemes. This study aimed to use their introduction in selected urban areas in England in 2020 as a natural experiment to test the ‘safety in numbers’ (SiN) hypothesis.4 This concept from road safety literature posits that as the number of people using active and micromobility transport (cyclists, pedestrians, e-bikes, and e-scooters) increases, there may be a protective effect decreasing the frequency and severity of collisions they are involved in. Comparing local authority districts that did and did not introduce e-scooter schemes from 2015–2023, there was on average around a 20% reduction in bicycle collisions, supporting SiN. This reduction was sustained beyond the temporary effects of the COVID-19 pandemic. As you would expect, intervention areas had higher rates of e-scooter collisions, but the differences were not statistically significant due to the very small number of recorded events.
References
1. Sexton V, Grimley C, Dale J, et al. Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data. BMC Med Inform Decis Mak 2025; 25(1): 52.
2. Li Y, Kurinczuk JJ, Alderdice F, et al. Pre-pregnancy care in general practice in England: cross-sectional observational study using administrative routine health data. BMC Public Health 2025; 25(1): 1101.
3. Simpson CH, Brousse O, Taylor T, et al. The mortality and associated economic burden of London’s summer urban heat island effect: a modelling study. Lancet Planet Health 2025; 9(3): e219–e226.
4. Edwards HB, de Vocht F, Jago R, et al. Risk of bicycle collisions and ‘safety in numbers’: a natural experiment using the local introduction of e-scooters in England. Inj Prev 2025; DOI: 10.1136/ip-2024-045569.
Featured photo by Jonas Jacobsson on Unsplash.
