Abstract
Sex education
This year’s Sex Education Forum survey shows inconsistent delivery of Relationship and Sex Education levels, with many feeling they have little input into the content or format. Many teenagers also reported little opportunity to talk about the topics at home. Perhaps a useful practice project could be working with local resources, for example school nurses and schools, to ensure access to high-quality information.
www.sexeducationforum.org.uk/resources/evidence/young-peoples-rse-poll-2021
Is COVID killing conferences?
I enjoyed David Oliver’s column in the BMJ earlier this year when he posed the question ‘Has covid killed the medical conference?’. While as a busy working parent there are advantages to being able to attend conferences remotely, I agreed with many of the thoughts expressed in this perceptive piece. There is enormous value in being brought physically together with colleagues, old and new, to share knowledge and ideas, to debate and innovate.
Oliver D (2022) Has covid killed the medical conference? British Medical Journal 376: o412. DOI: 10.1136/bmj.o412.
Quality improvement
I was delighted to see an article in the BMJ in March by Davey, Thakore and Tully on ‘Embedding quality improvement into medical training’, addressing an important aspect of undergraduate medical education, and one which there is plenty of scope to embed within primary care. Does your practice have medical students you could supervise performing a quality improvement (QI) project? The RCGP provide support for practices undertaking QI in the ‘QI Ready’ hub online, which offers a wealth of resources and tools to help in conducting QI projects.
Davey P, Thakore S and Tully V (2022) How to embed quality improvement into medical training. BMJ 376: e055084. DOI: 10.1136/bmj-2020-055084.
www.rcgp.org.uk/clinical-and-research/our-programmes/quality-improvement.aspx
The Big GP Consultation
This is a monthly webinar which, at the time of writing, was running from January to June of this year. Did any of you take part? Each month invited speakers present on pertinent topics to the world of general practice; March’s focus for example was recruitment and retention of the GP workforce, with Professor Dame Helen Stokes-Lampard involved in discussions. Reports of each of the monthly webinars are available to review at the weblink below. This seems such a good initiative, I wonder if it will continue after June.
Lifestyle advice in hypertension and diabetes
I was saddened, but not surprised, to see the results of an article in the British Journal of General Practice that looked at lifestyle advice given to patients with one of these two conditions from 2002 to 2017 in England. Results of the study concluded that very few patients reported receiving lifestyle advice, or had this documented in their notes. There is a wealth of evidence around the role of lifestyle factors, such as diet and physical activity, in hypertension and diabetes –does this suggest we need to make a more concerted effort to raise this with patients, check that they have understood the advice and power of lifestyle measures, and record this in the notes?
Henry A, Jebb S, Aveyard P, et al. (2022) Lifestyle advice for hypertension or diabetes: Trend analysis from 2002 to 2017 in England. British Journal of General Practice 0493. DOI: 10.3399/BJGP.2021.0493.
Wrongful conception
A show jumper who was born with a neural tube defect has successfully sued the GP who advised her mother about folic acid supplementation. The GP had written a very brief entry so was forced to rely on his ‘standard practice’. I think this reminds us how important note keeping can be in demonstrating what was shared in discussions. It is fairly easy to set up some templates for important conversations for things we do frequently, for example screening discussions or starting hormone contraceptives or replacements. A small library of key templates could be created with each healthcare professional setting up a topic and shares.
Boost or nudge?
Most of us will have had complex conversations about the pros and cons of vaccines, mask wearing and other COVID restrictions. Discussions I have had with hundreds of vaccine-hesitant people have reinforced the importance of shared decision making, not just telling people what to do. A BMJ article on boosting (equipping people with skills and tools to make better choices for themselves) gives some useful examples, such as brief statistical training, use of decision aids or learning temptation-resisting strategies.
Rouyard T, England B, Papanikitas A, et al. (2022) Boosting healthier choice. BMJ 36(320): 25–2. DOI: 10.1136/bmj-2021-064225.
Communication skills
Many of you may feel daunted by the clinical assessment component of the exam, currently the Recorded Consultation Assessment (RCA). The London Professional Support Unit has produced a long video on this that you and your trainer, or a group of you, could watch in sections. The focus is on thinking about how treating the consultation as a conversation can help you listen to the patient, respond to cues and try to find out what the patient wants. Many of us do things like using formulaic phrases or remain glued to our computers, so that we miss changes in voices or body language. This video gives some ideas about how you and your trainer or colleagues could improve consultations.
Shah R, Rustecki L, Payne N, et al. (2022) The language of connection. Available at: vimeo.com/user4672630/review/651088927/b56728738b (accessed 21 March 2022).
Racism in UK health research
COVID has given fabulous examples of collaborative research. It has however highlighted inequities. A recent BMJ article highlights barriers and proposes solutions to racism in UK health research. Research leaders are not diverse, racialised minority patients are not included as participants in UK health research, racialised minority applicants are less likely than white applicants to be awarded funding grants; the list goes on. I think it is worth reading this article and questioning what actions are being taken in your local area to improve equity in health research.
Powell R, Njoku C, Elangovan R, et al. (2022) Tackling racism in UK health research. BMJ 376(8323): 151–153. DOI: 10.1136/bmj-2021-065574.
Menopause
During lockdown, various publicity campaigns, including ones by the BBC and by Davina McCall, have highlighted the problems caused by the menopause, and the lack of access to support. A recent BMJ Sexual and Reproductive Health article usefully discussed a clinical vignette. If you find clinical scenarios helpful, Fourteen Fish is now hosting the Newson Health Menopause Society Community.
Gilmore K and Mansour K (2022) A case vignette describing management of menopausal symptoms and migraine in the perimenopause. BMJ Sexual and Reproductive Health 48: 72–77. DOI: 10.1136/bmjsrh-2020-200977.
Altogether Better
I belong to a Deep End group. Several people have referenced Altogether Better. This is an NHS national network organisation supporting health and social care services to introduce their model of Collaborative Practice. The website has patient and organisation stories and talks about inviting local people to gift their time to a local service, such as a GP service. It might be interesting to find out what sort of partnerships are working in your local area. Picking up the pieces after COVID has been very hard, and we have been talking with our patient group about how we could go on working together, in the very positive way we did for delivering vaccines.
Allyship
The RCGP has produced an e-learning module that focuses on allyship and bystander training. The course is available on the RCGP website. After doing the module you might want to think about sharing some of the ideas with your practice. Lean In has resources for teams to look at allyship and to look at ways of reducing bias.
ORCID iDs
Dr Clare Etherington https://orcid.org/0000-0002-1446-627X
Dr Kathryn Steven https://orcid.org/0000-0002-7534-2932