As requested by GP Trainees, this week's episode is on tips to pass the Simulated Consultation Assessment exam; the final exam for GP trainees in the UK. We spoke to Dr Anne Hawkridge who was a GP trainer in Bolton for over 20 years and has been a MRCGP examiner since 2007 when the CSA (Clinical Skills Assessment) started, the predecessor to the pandemic RCA and now the SCA. She is also the co-founder of the successful exam support programme here in the North West; the SOX programme (Support on Exams) and co-author of the North West England Consultation Toolkit which is published in full on the MRCGP SCA preparation website. Questions we had were; what is the exam, what does it look like, how much does it cost, when to consider sitting in, how to approach revising for it and what pitfalls to avoid. The top tips fit into 4 themes; GP consulting skills, ensuring knowledge, good exam technique and timing. Anne covers the changes in the exam through the recent years and there’s plenty in there to give people a flavour of how they can approach the exam in a way that will maximise their chance of success, as well as gaining skills for being a good GP.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)   Useful resources:  Interviews from successful North West Deanery Trainees: https://www.nwpgmd.nhs.uk/sca-resources We highly recommends listening to the interviews in full on the North West Deanery SCA resources site here https://www.nwpgmd.nhs.uk/sca-resources Royal College of General Practitioners Simulated Consultation Assessments Introduced and Explained with the Toolkit: https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment/introduction We recommend that you watch the short How to use the toolkit video: https://www.youtube.com/watch?v=AMHfHJVENfk Royal College of General Practitioners Red Amber Green (RAG) Rating Tool: https://www.rcgp.org.uk/getmedia/95fa6d76-b02d-41c8-873d-f1ccf576dd4b/sca-consultation-toolkit-rag.pdf North West England Deanery Website with information and tips on Passing the SCA: https://www.nwpgmd.nhs.uk/sca-resources The SCA-SOX Programme: https://heeoe.hee.nhs.uk/general_practice/sca-sox-programme ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Respiratory Physiotherapist Thomas James about COPD. We start with what COPD is, when to suspect it, a standard work up, pitfalls and points of consideration about spirometry, before moving on to an overview of management. We then cover some changes in the way COPD exacerbations are managed in South Manchester and the role of Eosinophils in both acute and chronic management. Understanding the role of Pulmonary rehabilitation, prednisolone and exercise in management are particular highlights. We cover our learning points from the episode at the end.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE COPD in adults (last updated Sept 2023): https://www.nice.org.uk/guidance/QS10 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Spirometry Guide: https://goldcopd.org/gold-spirometry-guide/ Association for Respiratory Technology and Physiology (ARTP) advice on Spirometry Interpretation: https://www.artp.org.uk/en/spirometry Greater Manchester Medicines Management Group (GMMMG) COPD Management Plan Guideline (2021): https://gmmmg.nhs.uk/wp-content/uploads/2021/11/COPD-Treatment-Guideline-Nov-2021-V7.1.pdf Greater Manchester Medicines Management Group (GMMMG) COPD Inhaler Guide (2021): https://gmmmg.nhs.uk/wp-content/uploads/2023/05/GMMMG-COPD-Inhaler-Guide-update-Mar-2023.pdf Greater Manchester CURE Project for Smoking Cessation: https://gmcancer.org.uk/programmes-of-work/treatment/the-cure-project/ Greater Manchester Change, Grow, Live Services including Smoking Cessation: https://www.changegrowlive.org/ Primary Care Respiratory Society MRC Breathlessness scale: https://www.pcrs-uk.org/mrc-dyspnoea-scale Our podcast with Dr Lesley Henson and Dr Caitriona MacDermott on Breathlessness in Palliative Care (May 2024): https://pckb.org/e/breathlessness-in-palliative-care/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Joanna Bircher, Dr Nikesh Vallabh, Shelley Ryder (SWAN PCN Manager and Transformation Lead) and Dr Fran Fitton. We find out what proactive care is all about and then launch into example projects around dementia care that Shelley and Fran are involved in. We hope this gives people a flavour of what proactive care projects could entail in General Practice in terms of design and implementation.  Later in the year, we hope to bring more examples of projects and how they managed to get them off the ground.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NHS Long Term Plan, Overview and Summary: https://www.longtermplan.nhs.uk/online-version/overview-and-summary/ Proactive care: New GM support offer for 20 PCNs: https://gmpcb.org.uk/proactive-care-new-gm-support-offer-for-20-pcns/ An Introduction to Quality Improvement: https://www.podbean.com/ew/pb-ubnht-114762e ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024*** To get in touch: [email protected] Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Palliative Care Consultant Lesley Henson and Specialty Doctor Caitriona MacDermott for a discussion on common issues Primary Care Clinicians face when dealing with patients at the end of life and their families. We discuss Hospice admission criteria and the role of the hospice. We then look at how they approach questions around palliative symptoms like breathlessness, reduced oral intake and this leads on to a conversation about assessing and discussing options around hydration. We get their approach to answering questions around prognosis and navigating the scenario where relatives/carers might see the set of symptoms differently to other carers.  Useful resources:  Hospice UK: What is Hospice Care: https://www.hospiceuk.org/information-and-support/your-guide-hospice-and-end-life-care/im-looking-hospice-care/what-hospice Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf Clinical Knowledge Summaries: Palliative Care General Issues: https://cks.nice.org.uk/topics/palliative-care-general-issues/ Pain Assessment Tool for People with Dementia or Communication Difficulties from Doncaster and Bassetlaw NHS Hospitals (2015): https://www.dbth.nhs.uk/wp-content/uploads/2018/10/DBH-Pain-Tool.pdf MacMillan Resources: Managing Breathlessness, advice for Patients: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness/managing-everyday-life-with-breathlessness?gad_source=1&gclid=cjwkcajwrckxbhbmeiwaivf8rhfcgjkvqpsq-is9gahloaxjoyq9tsfxwykwym08ewcsyoluupn-1xocq1sqavd_bwe&gclsrc=aw.ds Cancer Research UK Resource for Patients and relatives around Breathing Problems for Patients with Cancer: https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Palliative Care Consultant Lesley Henson and Specialty Doctor Dr Caitriona MacDermott about Breathlessness as a symptom in Palliative Patients. We start with a case to look at an approach to a patient with deteriorating breathlessness, before discussing a diagnosis of refractory breathlessness. We explore the importance of understanding the subjective nature of this experience before moving on to non-pharmacological and pharmacological options to help manage this often distressing symptom. We talk about managing anxiety around breathlessness and get their advice on discussions about death and managing these symptoms well.  Useful resources:  Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019 (p46, section on breathlessness): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf Clinical Knowledge Summaries: Palliative Care - Dyspnoea (Updated Feb 2024): https://cks.nice.org.uk/topics/palliative-care-dyspnoea/#:~:text=Managing%20dyspnoea%20in%20palliative%20care,window%2C%20relaxation%20and%20breathing%20techniques. MacMillan Resources: Managing Breathlessness, advice for Patients: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness/managing-everyday-life-with-breathlessness?gad_source=1&gclid=cjwkcajwrckxbhbmeiwaivf8rhfcgjkvqpsq-is9gahloaxjoyq9tsfxwykwym08ewcsyoluupn-1xocq1sqavd_bwe&gclsrc=aw.ds Cancer Research UK Resource for Patients and relatives around Breathing Problems for Patients with Cancer: https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Saadat Ahmed, ST5 in Geriatrics for a deep dive into Osteoporosis. We cover what it is, why it matters, what the risks factors are, who and how to assess for it, and what to do with results from FRAX and DXA scans. After a discussion on lifestyle options to help improve bone health, we ask advice on counselling patients around the pros and cons of taking Bisphosphonates including his advice on talking about the rarer side effects. We talk through a case and ask advice on how to reassess bone health after these initial conversations, and medications might have been started, including when to consider drug holidays.   Lots of excellent CPD here we feel. Enjoy and please share with any interested clinicians/trainees as you see fit.   Useful resources:  Osteoporosis - Prevention of Fragility Fractures NICE CKS Guidelines (updated Apr 2023): https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/ FRAX Calculator UK (Link from National Osteoporosis Guideline Group UK: https://frax.shef.ac.uk/FRAX/tool.aspx?country=1 WHO Falls Management: https://www.who.int/news-room/fact-sheets/detail/falls National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/full-guideline/section-4-intervention-thresholds-and-strategy https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk SIGN Scottish Osteoporosis Guidelines (discussion of evidence for links between PPIs and Osteoporosis on page 27): https://www.sign.ac.uk/media/1812/sign-142-osteoporosis-v3.pdf Osteonecrosis of the Jaw relative risk discussed on page 37 of National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus, Journal of Bone and Mineral Research. Khan A et al 2015: https://pubmed.ncbi.nlm.nih.gov/25414052/ Flow Chart for Oral Bisphosphonates long term treatment and monitoring NOGG Guidelines: Page 35: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf Rubin KH, Rothmann MJ, Holmberg T, et al. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporosis Int 2018; 29(3): 567-78. https://pubmed.ncbi.nlm.nih.gov/29218381/ Merlijn T, Swart KM, van Schoor NM, et al. The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial. J Bone Miner Res 2019; 34(11): 1993-2000. https://pubmed.ncbi.nlm.nih.gov/31220365/ Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporosis Int 2020; 31(2): 251-7. https://pubmed.ncbi.nlm.nih.gov/31838551/ _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to GPs Dr Joanna Bircher, Dr Lucy Spurrell and Dr Dario Rydel about their experiences in different roles in General practice; salaried, partner and locum. The aim of the episode is for GPs or GP trainees listening to get a flavour of their experiences and to understand the pros and cons of each of those roles in general practice, with a particular focus on the partnership model and the benefits of becoming a partner. Useful resources:  GPOnline Talking General Practice Podcast, Dr Katie Bramall-Stainer on the GP contract and the fight for a better deal: https://www.gponline.com/podcast-dr-katie-bramall-stainer-gp-contract-fight-better-deal/article/1865234 The Leadership Hike Book:: https://www.amazon.co.uk/Leadership-Hike-Shaping-Primary-Together/dp/0367236982 Medics Money podcast: https://www.medicsmoney.co.uk/medical-accounting-blog/?catname=podcasts GP Excellence: https://gmpcb.org.uk/general-practice/gp-excellence/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Tim Dalton, a GP in Wigan, and Chair of the Greater Manchester GP Provider Board. The focus of today’s episode is all about how general practice is funded. They cover how it is different from other NHS settings, the sources of income in general practice and the flow of money through the system, DES’, LES’ and QOF, the place of PCNs and Federations, as well as talking about different types of GP contracts and what these mean. To note: this was recorded in March 2024, just before the new contract details were released and so doesn't contain the specifics of the new contract. Useful resources:  The Kings Fund: GP funding and contract explained: https://www.kingsfund.org.uk/publications/gp-funding-and-contracts-explained NHS England: GP Contract: https://www.england.nhs.uk/long-read/gp-contract/ GPOnline Talking General Practice Podcast, Dr Katie Bramall-Stainer on the GP contract and the fight for a better deal: https://www.gponline.com/podcast-dr-katie-bramall-stainer-gp-contract-fight-better-deal/article/1865234 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined this week by Satty Boyes (Senior programme manager) and  Lorna Laflin (Previous Practice Manager who works with the GP Excellence team). They discuss a new platform in Greater Manchester for the non-clinical workforce within General Practice, which allows staff to explore progression pathways,  track their professional progress, and access learning opportunities all in one place.  Some quotes from those who have accessed the platform already:  “I think this is an absolutely wonderful tool and wish that there had been something like this available when I first started my career with the NHS. Easy to use and lots of really useful information. I would be really inclined to push some of my administration staff to enrol for the passport to develop their skill-set. A wonderful piece of work. Well done to the team for pulling this all together.”   “Useful for everyone to understand that career progression pathways ARE available if they wish to progress. Very useful to see standardised Job Descriptions and training pathways all in one place.” Useful resources:  Greater Manchester Non-Clinical Workforce Programme: https://gmprimarycare.org.uk/primary-care-passport/non-clinical-workforce-programme/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Specialty Doctor Caitriona MacDermott about anticipatory prescribing for Palliative patients. An area where there has been much learning over the last several years, it is a good opportunity to get some teaching on why this is the case, the stages involved in recognition and addressing symptoms at the end of life, the need for regular reviews in terms of the potential for change and her advice on how she opens up conversations around future needs, death and symptom control.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf NICE Guidelines related to caring for Adults at the End of Life: https://www.nice.org.uk/guidance/ng142 The Gosport Independent Panel Report: https://www.gosportpanel.independent.gov.uk/ RCGP End of life and palliative care toolkit: https://elearning.rcgp.org.uk/mod/book/tool/print/index.php?id=12529&chapterid=272 Compassion in Dying Information on Do Not Resuscitate Forms and CPR decisions for Patients: https://compassionindying.org.uk/how-we-can-help/do-not-resuscitate-dnr-forms-and-cpr-decisions/ British Journal of General Practice: The Liverpool Care Pathway for the dying, what went wrong? Knights D, Wood D, Barclay S (2013: 63): https://bjgp.org/content/63/615/509/tab-article-info ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is the second episode in our MSK mini-series. Doctors Lisa and Sara speak to Tom Smith and Charlotte Barker again, who are First Contact Practitioners in Wigan. The focus of this chat is shoulder pain - using a hypothetical case to discuss important history points, red flags, useful examination tips, differential diagnoses and further assessment options. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Escape Pain: https://escape-pain.org/ Be Well Wigan: https://www.wigan.gov.uk/BeWell/index.aspx Versus Arthritis: https://versusarthritis.org/ Age UK: https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/arthritis/ NICE CKS Guidelines for Knee Pain: https://cks.nice.org.uk/topics/knee-pain-assessment/ NICE Osteoarthritis Guideline (NG226): https://www.nice.org.uk/guidance/ng226 NHS Decision Making Tool for Knee Osteoarthritis: https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-knee-osteoarthritis/  Patient Exercise Options: https://www.nhs.uk/conditions/nhs-fitness-studio/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is the second episode in our MSK mini-series. Doctors Lisa and Sara speak to Tom Smith and Charlotte Baker again, who are First Contact Practitioners in Wigan. The focus of this chat is shoulder pain - using a hypothetical case to discuss important history points, red flags, useful examination tips, differential diagnoses and further assessment options. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  British Elbow and Shoulder Society guidelines: https://bess.ac.uk/national-guidelines/ British Elbow and Shoulder Society pathways: https://bess.ac.uk/patient-care-pathways-and-guidelines/ ShoulderDoc: https://www.shoulderdoc.co.uk/ Patient Exercise Options: https://www.nhs.uk/conditions/nhs-fitness-studio/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is the first episode in a three part MSK mini-series, which aims to briefly capture important features in history, examination and further investigations of common joint presentations. Doctors Sara and Lisa speak to Tom Smith and Charlotte Baker who are First Contact Physiotherapists in Wigan. Back pain is the focus of this episode, with a fictional case used to chat through history, examination, red flags and further assessment of this very common primary care topic. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Getting it right first time (GIRFT): https://gettingitrightfirsttime.co.uk/interactive-pathway-to-help-diagnose-and-treat-cauda-equina-syndrome-without-delay-is-now-live/ National Spine Network, National Back Pain and Radicular Pain Pathway: https://www.nationalspinenetwork.co.uk/National-Back-Pain-and-Radicular-Pain-Pathway  MACP cauda equina information cards: https://www.macpweb.org/learning-resources/cauda-equina-information-cards.aspx NICE guidelines for back pain and sciatica: https://www.nice.org.uk/guidance/ng59 International Framework for Red Flags for Potential Serious Spinal Pathologies - Finucane et al 2020: https://www.jospt.org/doi/epdf/10.2519/jospt.2020.9971 Patient Exercise Options: https://www.southtees.nhs.uk/services/back-pain/backtracks/my-backtracks-playlist/ Patient Exercise Options: https://www.nhs.uk/conditions/nhs-fitness-studio/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with Dr Anne Connolly, a GP with a special in Gynaecology, trained hysteroscopist, and founding member of the Primary Care Women's Health Forum, where she just stepped down as chair in 2023. They speak about the importance of raising awareness about women’s health problems such as heavy menstrual bleeding, how underappreciated it can be, and the impact it can have on women’s lives. They then use cases to illustrate the assessment and management of heavy menstrual bleeding, making sure to touch on risk factors, concerning features and differentials. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Who pays this doctor: https://www.whopaysthisdoctor.org/ Primary care women’s health forum: https://pcwhf.co.uk/# NICE NG88 Heavy Menstrual Bleeding Guidelines (May 2021): https://www.nice.org.uk/guidance/ng88 NICE guidelines for Red Flags for Gynaecological Cancers (Updated Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers Cancer Research UK: https://www.cancerresearchuk.org/about-cancer/ Jo’s Trust for Cervical Cancer: https://www.jostrust.org.uk/ The Eve Appeal: UK Charity funding research and raising awareness of the five gynaecological cancers – womb, ovarian, cervical, vulval and vaginal: https://eveappeal.org.uk/ Go Girls: UK Charity Supporting Women with gynaecological cancers: https://www.gogirlssupport.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Mahindra Chincholkar, a consultant anaesthetist and Clinical Director Manchester and Salford Pain Centre. They take a detailed dive into the concept of pain and chronic pain, and then Mahindra explains his stepwise approach to assessing and managing chronic pain through the use of an anonymous case.  This episode is being released now to tie in with the forthcoming Greater Manchester Pain Management Resources Hub which has been co-designed with healthcare professionals and people with lived experience of pain, for use by healthcare professionals supporting people living with pain. You can complete this form to be notified once it is available: https://forms.office.com/e/qgrxwP3PTZ You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Case report about nail in the boot (original article unaccessible): Fisher et al BMJ 1995 Permission to Move Book: https://www.permissiontomove.com/books Tame the Beast: https://www.tamethebeast.org/#tame-the-beast Flippin’ Pain: https://flippinpain.co.uk/ British Pain Society: https://www.britishpainsociety.org/ Faculty of Pain Medicine: https://fpm.ac.uk/ The Pain Toolkit: https://www.paintoolkit.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa discuss the podcast episodes over the year. We talk about our longer term learning points, how the year has gone and what's to come. ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Sadaat Ahmed about Frailty. We discuss definitions, frailty syndromes, frailty scores and the need to take care with these. We talk through a case to showcase how recognising frailty and managing the controllable areas can make a big difference to patients' lives and slow or even sometimes reverse frailty.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  British Geriatrics Society Fit For Frailty Guidelines: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty British Geriatrics Society Comprehensive Geriatrics Assessment Primary Care Toolkit: https://www.bgs.org.uk/resources/resource-series/comprehensive-geriatric-assessment-toolkit-for-primary-care-practitioners National Osteoporosis Guidelines Group: https://www.nogg.org.uk/ British Geriatrics Society Frailty eLearning Hub: https://www.bgs.org.uk/elearning-0 The dangers of diagnosing frailty based on automatically calculated electronic Frailty Scores: https://www.england.nhs.uk/wp-content/uploads/2017/04/gms-contract-batch-coding-statement.pdf RCGP Internal and External Resources around Frailty: https://www.rcgp.org.uk/your-career/gp-extended-roles/Useful-resources-for-frailty ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

The importance of addressing climate change and sustainability is gaining more traction across the NHS. In order to find out more about the situation, and what can be done within Primary Care, Doctors Sara and Lisa talk to Dr David McKelvey who is a GP from Salford and NHS Greater Manchester Integrated Care Clinical Lead in Sustainability in Primary Care. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Primary Care Provider Board - Sustainability in general practice: https://gmpcb.org.uk/sustainability/sustainability-in-general-practice/ Greater Manchester Medicines Management Group - Three steps for Greener Respiratory Care: https://gmmmg.nhs.uk/wp-content/uploads/2022/08/Greener-inhaler-poster-Staff-FINAL.pdf Patient decision aid on asthma inhalers and climate change (Aug 2022): https://www.nice.org.uk/guidance/ng80/resources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573 The GP Excellence Podcast - How can you support sustainability in General Practice? https://omny.fm/shows/gp-excellence-podcast/how-can-you-support-sustainability-in-general-prac Royal College of General Practice Climate change and sustainability resources page: https://www.rcgp.org.uk/representing-you/policy-areas/sustainable-development Royal College of General Practice Net Zero Hub: https://elearning.rcgp.org.uk/course/view.php?id=650 10 Step Plan for Primary Care Sustainability in GM https://gmpcb.org.uk/sustainability/sustainability-10-step-plan/ Planetary Boundaries – an up-to-date interview between Kevin Anderson and Johan Rockstrom.  https://www.youtube.com/watch?v=lLq8e73-FAw The 2023 state of the climate report - Entering uncharted territory: https://academic.oup.com/bioscience/advance-article/doi/10.1093/biosci/biad080/7319571 NHS Green Plan – a video about what’s happening. https://youtu.be/Nap2p4EeUQo Greater Manchester Greener Practice Group: https://www.greenerpractice.co.uk/join-our-network/local-groups/greater-manchester/ Take the jump – steps individuals can do: https://takethejump.org/ Open Prescribing Green NHS: https://openprescribing.net/icb/QOP/measures/?tags=greenernhs Health for Extinction Rebellion: https://healthforxr.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to a GP involved in Primary Care Research Dr Imran Ghafoor and Ewa Grzegorska, a Research Support Facilitator from the National Health and Clinical Research Institute about Research in Primary Care. We talk through Dr Ghafoor’s journey into being part of Primary Care Research, what embarking on Research Projects in Primary Care might look like, from the straightforward to the more involved, and some of the practicalities and financial considerations.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  If you want to contact the research Team from today Directly: [email protected] or  [email protected] National Institute of Health and Care Research: https://www.nihr.ac.uk/ Clinicians wanting to Train up in Research Initial Training Module Good Clinical Practice (through National Institute for Health and Care Research): https://www.nihr.ac.uk/health-and-care-professionals/learning-and-support/good-clinical-practice.htm Implementation of inclisiran in UK primary care for patients with atherosclerotic cardiovascular disease (ASCVD) or ASCVD-risk equivalents: rationale and design of VICTORION-Spirit, a pragmatic phase IIIb, randomised controlled study: https://www.ijclinicaltrials.com/index.php/ijct/article/view/672 Safety and Efficacy of Dexpramipexole in Eosinophilic Asthma (EXHALE): A randomized controlled trial (mentioned and not published yet): https://pubmed.ncbi.nlm.nih.gov/37277072/ National Institute of Health and Care Research List of Possible Studies of Interest: https://bepartofresearch.nihr.ac.uk/results/search-results Some Primary Care professionals may also want to be a participant in research (which in itself is a nice way to see what it's all about). The best way to do this is to go to https://www.researchforthefuture.org/  ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

To find out more about how Dentistry works in England, Doctors Lisa and Sara talk to Greater Manchester Workforce Lead for Dentistry Mukhtar Ahmad. We cover how Dental Services are set up and funded in England and some current challenges. We move on to specific questions about how General Practice and Dentistry can help each other. Themes include; information sharing, Bisphosphonates, Chemotherapy, Radiotherapy and Diabetes.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  BMA Advice and Support Patients presenting with dental problems (Sept 2020): https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/patients-presenting-with-dental-problems?fbclid=IwAR1-rLLfHumLXMZSXxnb8UF_4acvgbTTcPYmvSQHa8VX18fM0Yn-8fCBoAk Scottish Dental Resources for Professionals: https://www.scottishdental.org/professionals/ Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs (March 2022): https://www.sdcep.org.uk/published-guidance/anticoagulants-and-antiplatelets/ NHS Choices: Find A Dentist: https://www.nhs.uk/service-search/find-a-dentist Baby Teeth Do Matter: https://babyteethdomatter.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Senior Eating Disorder Practitioners Vicky McGee and Rachelle Davies to get their advice on consulting with children and young people who present with features of an Eating Disorder. We take the theoretical case of 14-year-old Suzie, who presents to the Practice alongside her Mum with mood symptoms, reduced eating and weight loss. We use this to guide the discussion around consulting with children and young people and assessing for an Eating Disorder. We talk about Red Flags during acute assessment and follow up. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Medical Emergencies in Eating Disorders: Guidance on Recognition and Management (Updated July 2023 - Traffic Light System Starts p31): https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233-medical-emergencies-in-eating-disorders-(meed)-guidance.pdf?sfvrsn=2d327483_52 NICE Guidelines Eating disorders: recognition and treatment  (Dec 2020): https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-treatment-pdf-1837582159813 Royal College of General Practice Eating Disorders eLearning: https://elearning.rcgp.org.uk/enrol/index.php?id=173 Children and young people with suspected eating disorders: Guidelines for primary care professionals (Greater Manchester Focus): https://hub.gmintegratedcare.org.uk/mental-health/children-and-young-people-with-suspected-eating-disorders-guidelines-for-primary-care-professionals/ Eva Musby, a resource for Parents and Clinicians around Anorexia Nervosa: https://anorexiafamily.com/ Maudsley Model in Eating Disorder Treatment: https://www.eatingdisorderhope.com/blog/maudsley-model-eating-disorder Guidelines Summary for Primary Care: Management of Eating Disorders (lists specific types): https://www.medscape.co.uk/viewarticle/eating-disorders-2022a10019oa FEAST (Families Empowered And Supporting Treatment for Eating Disorders) Resources for Families: https://www.feast-ed.org/ Beat Eating Disorders: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to GPs and Workforce Leads Dr Nikesh Vallabh and Dr Richard Bircher. They wanted to talk to us today to discuss a practical approach to some of the workforce issues we are all facing. This episode will be particularly useful for GP Partners, Practice Managers and anyone interested in workforce issues in General Practice. The clicking into the episode will bring up a large list of resources for people to check out as well.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NHS Long term Workforce Plan (June 2023):  ttps://www.england.nhs.uk/long-read/accessible-nhs-long-term-workforce-plan/ National offers to support GPs, including information on Returning to General Practice, GP retainer Scheme, International GP recruitment and the GP Fellowship Scheme: https://www.england.nhs.uk/gp/the-best-place-to-work/ Greater Manchester Primary Care Provider Board: New Access Models with Worked Examples: https://gmpcb.org.uk/general-practice/new-access-models/ GM Primary Care Provider Board website with links to case studies for new models of care to improve access: https://gmpcb.org.uk/general-practice/new-access-models/ Our Previous Episode ‘Changing Access Models in General Practice’: https://www.podbean.com/ew/pb-nw7rc-13ca7c0 NHS England GP Fellowship Programme: https://www.england.nhs.uk/gp/the-best-place-to-work/gp-fellowship-programme/ Health Education England GP Fellowship Programme: https://www.hee.nhs.uk/our-work/gp-fellowships Health Education England North West Professional and Educational Development Course (for GPs): https://nwpgmd.nhs.uk/professional-education-and-development-course-ped Greater Manchester Training Hub (access to lots of different training opportunities for General Practice Staff as well as Coaching and Mentorship Courses): https://gmthub.co.uk/ GP careers: Becoming a GP trainer: Article on GP Online (Jan 2022): https://www.gponline.com/gp-careers-becoming-gp-trainer/article/1424835 Health Education England General practice educator, assessor, coach or mentor: https://www.hee.nhs.uk/our-work/primary-care/general-practice-educator-assessor-coach-or-mentor GPs Return to Practice: https://www.england.nhs.uk/gp/the-best-place-to-work/returning-to-practice/#:~:text=A%20national%20support%20team%20means,educational%20needs%20of%20each%20GP National GP Retention Scheme: https://www.england.nhs.uk/gp/the-best-place-to-work/retaining-the-current-medical-workforce/retained-doctors/ Health Education England Apprentices in primary care - success in practice! https://www.hee.nhs.uk/sites/default/files/documents/Apprentices%20in%20primary%20care%20Mar%202017_0.pdf Gov.uk Education Hub Blog: NHS doctor apprenticeships: Everything you need to know (June 2023): https://educationhub.blog.gov.uk/2023/06/30/nhs-doctor-apprenticeships-everything-you-need-to-know/ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/ (Direct link to page with infographic for GPs Career paths): https://gmprimarycarecareers.org.uk/generalpractice/careers/general-practitioner/ Information on becoming a learning environment: https://gmthub.co.uk/placements/health-professions-in-social-care/becoming-an-accredited-learning-environment ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Aseem Mishra to discuss changes in the guidelines for Hypertension. The discussion includes advice on how to get the most accurate diagnosis and measurements for blood pressures, the importance of counselling patients well, and advice on medications. We started with a poem from Aseem focusing around why this is such an important topic. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE Clinical Knowledge Summaries (updated March 2023): https://cks.nice.org.uk/topics/hypertension/ NICE Visual Summary of Hypertension Diagnosis and Management (Aug 2019): https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517 European Society of Hypertension Guidelines: https://www.eshonline.org/guidelines/2023-guidelines/ Greater Manchester Medicines Management Group (GMMMG) Hypertension Toolkit (Sept 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/09/GM-Hypertension-Pathway-V9.2-Final.pdf Antonios T116 Antihypertensive drug concordance in patients with apparent resistant hypertension: a tertiary hypertension referral centre experience Heart 2019;105:A97 https://heart.bmj.com/content/105/Suppl_6/A97.1 Blood Pressure UK (good resources including patient booklets: https://www.bloodpressureuk.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk with Consultant Psychiatrist Dr Mark Spurrell about a framework that can be applied to the care of complex patients with multiple problems or difficulties. It is particularly useful at times where we feel stuck, we are struggling to help or move forward and care may be fragmented with lots of care professionals feeling similarly. The idea is to use a value based approach using the whole team to breathe new life into the scenario, create positivity and momentum and build on this to help generate better outcomes for patients that are tailored to their values.  The idea is originally for the MDT approach of Mental Health work but it has been interesting to discuss the approach for General Practice Patients.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Spurrell M, Potts L, Shaw A. Framing Value Based Healthcare in Practice: Introducing the Complex Case and Recovery Management Framework (The CCaRM). Int J Integr Care. 2023 Jan 9;23(1):1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838237/ Dr Mark Spurrell Website with resources: www.mark-spurrell.com Shared Decision Making Summary guide NHS England and NHS Improvement Feb 2019: https://www.england.nhs.uk/wp-content/uploads/2019/01/shared-decision-making-summary-guide-v1.pdf Royal College of GPs 2016: Collaborative Care and Support Planning: Ready to be a reality https://elearning.rcgp.org.uk/pluginfile.php/174399/mod_book/chapter/576/RCGP-CCSP-Ready-to-be-a-Reality.pdf The Good Lives Model, a strengths-based approach to offender rehabilitation that can be used in other areas: https://www.goodlivesmodel.com/ Recovery Star The Outcomes Star for mental health and well-being: https://www.outcomesstar.org.uk/using-the-star/see-the-stars/recovery-star-4/ NHS Examples of survey tools for use in supported self-management: https://www.england.nhs.uk/personalisedcare/supported-self-management/health-system-support-framework-for-supported-self-management/examples-of-survey-tools-for-use-in-supported-self-management/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Optometrist Dharmesh Patel to get an understanding of Optometry as part of the Primary Care Team. We discuss how the service is set up, what can be done at the Opticians, different types of patient access and how GP practices can link in with services. We discuss the Community Urgent Eye Care Service (CUES), Minor Eye Conditions Service (MECS) and Community Eye Care Service (CECS). We take a few examples of cases to illustrate options for accessing services in Greater Manchester. Check out the links in the resources section for more about these services.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Generic Introduction to Optometry and Opticians in the UK for Patients: https://www.nhs.uk/nhs-services/opticians/visiting-an-optician/ Criteria for Free NHS eye checks: https://www.nhs.uk/nhs-services/opticians/free-nhs-eye-tests-and-optical-vouchers/ Easy Eyecare Pathway Pathway to support patients with Disabilities and Autism: https://www.gov.uk/government/publications/eye-care-and-people-with-learning-disabilities/eye-care-case-study-community-eye-care-pathway Primary Eyecare Services including finding nearest practices with Community Urgent Eye Care Service (CUES), Minor Eye Conditions Service (MECS) or Community Eye Care Service (CECS): https://primaryeyecare.co.uk/find-a-practice/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to GP Dr Charlotte Bădescu about Ovarian Cancer. We focus on the important learning points about cardinal and other features of presentations to better understand this cancer as an abdominal cancer with symptoms that can and do often present much earlier than the diagnosis is often picked up. She talks us through the value of CA125 tests and the reasons not to be overly reliant on them, though they can be a useful tool in the tool box. The usefulness of ultrasound scans, both pelvic and transvaginal, as well as clinician continuity is discussed.  We go through 2 hypothetical cases based on real examples as well as Charlotte’s own diagnosis. An excellent episode for picking up great learning points to avoid missing this diagnosis in your own patients.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE Guidelines: Suspected Cancer, Recognition and Referral (Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers NICE guidelines on Ovarian Cancer (Published April 2011): https://www.nice.org.uk/guidance/cg122 GP network & resources: https://targetovariancancer.org.uk/health-professionals/GPs Nurses network & resources: https://targetovariancancer.org.uk/health-professionals/nurses Patient resources: https://targetovariancancer.org.uk/support-for-you Shine Cancer Support: https://shinecancersupport.org/ ForteenFish Free Ovarian Cancer Webinar (you will need to log-on and search Ovarian Cancer): https://www.fourteenfish.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by Community Pharmacist and Director of Pharmacy Transformation for Greater Manchester Luvjit Kandula. We learn all about the Essential Services and Enhanced Services Community Pharmacies are engaged in and get an understanding of the pressures Community Pharmacies are under. We discuss the plans for upcoming transformations and top tips to avoid errors in prescribing and to help take some of the pressure off Pharmacy teams.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  The Kings Fund, Community Pharmacies Explained: https://www.kingsfund.org.uk/publications/community-pharmacy-explained Primary Care Demand: Supporting General Practice and Community Pharmacy (Greater Manchester: https://greater-manchester.communitypharmacy.org.uk/wp-content/uploads/sites/118/2022/11/Primary-Care-Demand_Supporting-General-Practice-and-Community-Pharmacy_October-2022_Final.pdf Community Pharmacist Consultation Service (includes links to training Webinar, list of conditions, demos and case studies): https://gmpcb.org.uk/general-practice/gp-community-pharmacist-consultation-service/ Greater Manchester Primary Care Provider Board Community Pharmacy Hub: https://gmpcb.org.uk/community-pharmacy/ Save our pharmacies campaign: https://saveourpharmacies.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined this week by Dominic Anderson (Programme Director of the Health and Wellbeing Programme Greater Manchester), Lorna Laflin (Former Practice Manager who works with the GP Excellence team) and Joanna Bircher (GP and Programme Director for GP Excellence). We discuss the new QOF indicators around Workforce and Wellbeing in General Practice. We learn what the indicators are and get hints and tips about how to achieve them. We come at this slightly sceptical of the workload this might put on practices but are glad of the opportunity to talk thought the underlying principles of trying to support practices, what that support might look like and how to approach this in a quality improvement way that might help all staff, including those charged with collecting this data. This leads us to talk about Compassionate leadership. Please check out our episode resources for links and guides to these things.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  New wellbeing QOF indicator to reduce GP burnout risk, Pulse Article March 2023: https://www.pulsetoday.co.uk/news/clinical-areas/mental-health-and-addiction/new-wellbeing-qof-indicator-to-reduce-gp-burnout-risk/ Quality and Outcomes Framework guidance for 2023/24: https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2023-24/ Greater Manchester Resilience Hub: https://www.penninecare.nhs.uk/gmrh Greater Manchester Health and Wellbeing Resources: https://gmprimarycare.org.uk/workforce/health-and-wellbeing/ King’s Fund Kind and Compassionate Leadership Online Learning Resource: https://www.kingsfund.org.uk/courses/introduction-kindness-compassion-health-and-social-care Kindness Leadership Network: https://carnegieuktrust.org.uk/publications/commitment-to-kindness/ Book: West M. Compassionate Leadership; sustaining wisdom, humanity and presence in health and social care. The Swirling Leaf Press. London, 2021:  https://www.amazon.co.uk/gp/product/0995766975/ref=dbs_a_def_rwt_bibl_vppi_i1 Podcast: The Compassionate Leadership Interview with Chris Whitehead: https://www.podbean.com/podcast-detail/cdwzg-b7b51/The-Compassionate-Leadership-Interview-Podcast Book:  The Leadership Hike: Shaping Primary Care Together. Rughani A, Bircher J. CRC Press 2020: https://www.waterstones.com/book/the-leadership-hike/amar-rughani/joanna-bircher/9780367236984 Staff Risk Assessments with Templates. Health and Safety Executive Website, Managing Risk and Risk Assessments at Work: https://www.hse.gov.uk/simple-health-safety/risk/index.htm Looking after you too Coaching Support from NHSE: https://www.england.nhs.uk/supporting-our-nhs-people/support-now/looking-after-you-confidential-coaching-and-support-for-the-primary-care-workforce/looking-after-you-too/ Dominic Anderson's email address for those with additional questions or wanting support in Greater Manchester: [email protected] ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with Dr Uma Marthi who is a GP with a Specialist Interest in Gynaecology about red flags for gynaecological cancers. We discuss some cases based on real patients that involve cervical, vaginal and endometrial cancers. We’ll be recording a separate episode around the varied presentations of Ovarian cancer.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE guidelines for Red Flags for Gynaecological Cancers (Updated Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers Cancer Research UK: https://www.cancerresearchuk.org/about-cancer/ Jo’s Trust for Cervical Cancer: https://www.jostrust.org.uk/ The Eve Appeal: UK Charity funding research and raising awareness of the five gynaecological cancers – womb, ovarian, cervical, vulval and vaginal: https://eveappeal.org.uk/ Go Girls: UK Charity Supporting Women with Gynaecological Cancers: https://www.gogirlssupport.org/ BMJ Research Article: Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study (April 2019): https://www.bmj.com/content/365/bmj.l1161 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

**Summer Rewind: This episode was first released on Nov 30th 2022** Doctors Lisa and Sara talk to Consultant Otolaryngologist Ms Emma Stapleton and Clinical Scientist David Jay about Vertigo. We discuss the definition, differentials, and how to use information around timing and triggers to differentiate between the likely causes of vertigo. We get their take on the important details in the examination that can help identify the diagnosis, and talk options for managing the most common types of peripheral vertigo. The resources section of the episode description contains excellent resources to help, including examples of how to perform and interpret the Head Impulse test, as well as vestibular rehabilitation resources for patients.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE . Nov 2009, Stroke: https://pubmed.ncbi.nlm.nih.gov/19762709/ A summary of HINTS by David Jay: Developments in diagnostic approaches for acutely dizzy patients: (Feb 2020 ENT & Audiology News): https://www.entandaudiologynews.com/features/audiology-features/post/developments-in-diagnostic-approaches-for-acutely-dizzy-patients TiTrATE: A Novel Approach to Diagnosing Acute Dizziness and Vertigo. Newman-Toker and Edlow J A. Neurology Clinics (Aug 2015)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522574/ The Five Deadly D’s of Dizziness (red flags to remember): EM Resident, Unravelling the Mystery of Dizziness in the ED: A Guide for the Student Clerkship, Oct 2018 Wilcox K, Shafer K: https://www.emra.org/emresident/article/dizziness/ BMJ Vertigo: Dix-Hallpike Video: https://www.youtube.com/watch?v=8RYB2QlO1N4 BMJ Vertigo: Epley Manoeuvre Video: https://www.youtube.com/watch?v=jBzID5nVQjk&t=44s Examples of how to perform the Head Impulse Test for Peripheral Vestibular Dysfunction:             https://www.youtube.com/watch?v=psyPED6anPo             https://www.youtube.com/watch?v=XpghlvnrREI Professor Lucy Yardley: Retraining your Balance: https://www.menieres.org.uk/files/pdfs/balance-retraining-2012.pdf VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients:  Main Page: https://vestibular.org/ VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients:  Type of Vestibular Disorders Page: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/ Meniere’s Society UK: https://www.menieres.org.uk/ The Migraine Trust: https://migrainetrust.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with GP Dr Allison Rees for her advice on how to approach GP Appraisals and Revalidation. We heard her talk about this in a Health Education England First Five talk a few years ago and found it so helpful. We cover why they can be useful, the practicalities of what needs to be done and how to make them work for you.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  RCGP Guide to your Appraisal: https://www.rcgp.org.uk/your-career/revalidation/supporting-information-guidance Advice and Guidance for Locum Doctors and Doctors in Short Term Placements: https://www.england.nhs.uk/professional-standards/medical-revalidation/doctors/locum-ad/ RCGP Appraisal and Revalidation Mythbusters: https://www.rcgp.org.uk/your-career/revalidation/mythbusters NHS England Greater Manchester GP Fellowship scheme for GPs within 2 years of Qualifying: https://www.gmthub.co.uk/our-programmes/gp-fellowship New to Practice Health Education England Fellowship: https://madeinheene.hee.nhs.uk/general_practice/Primary-Care-Training-Hub/GP-GPN-Fellowship-Programme/New-to-Practice-Fellowships The Revalidation Management System (RMS): https://rms.england.nhs.uk/Account/Login?ReturnUrl=%2f Medical Appraisal Guide 2022: https://www.aomrc.org.uk/wp-content/uploads/2022/06/Medical_Appraisal_Guide_2022_0622.pdf National Association of Sessional GPs: https://www.nasgp.org.uk/ The General Medical Practice Framework for Appraisal and Revalidation: https://www.gmc-uk.org/-/media/documents/The_Good_medical_practice_framework_for_appraisal_and_revalidation___DC5707.pdf_56235089.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Wasim Javed, ST6 in Cardiology, about the diagnosis and management of Angina. Taking a theoretical case we talk through symptoms, differentials, diagnosis, including the guidelines and practicalities of different types of functional and non-functional tests, as well types of angina and their management. It was useful to understand the initial management once diagnosed, and where further investigations or referrals/discussions with cardiology come in. As well as the above, we discuss the difference between medical management and stenting and some of the third line anti-anginal medications.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE guidelines on Stable Angina (updated July 2016): https://www.nice.org.uk/guidance/cg126 European Society of Cardiology 2019 Guideline on Chronic Coronary Syndromes: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes Life in the Fast Lane (ECG interpretations etc): https://litfl.com/library/ Traffic Light System for Primary Care Prescribing in Greater Manchester (contains information on what should be started by Specialists etc): https://gmmmg.nhs.uk/rag-category/adult/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to talk to Dr Mary Cheshire who is the GP lead on the NHS England Fellowships for Greater Manchester GPs. As she explains, this is a fairly informal fellowship done over 2 years offering different types of courses and support that essentially consists of a paid CPD session a week and a range of CPD events to facilitate this. The course runs a qualification in coaching people can sign up for and are offered Mentors. Completing a quality improvement project is encouraged, whether that is small or large and there are opportunities for support for this along the way. At the moment this is available for newly qualified GPs and those up to 2 years after CCT who are in Salaried or Partnership posts.  There are other types of Fellowships - we mention the Health Education England GP Fellowships and GP Nurses Fellowships briefly, see details below.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  The Greater Manchester Training Hub GP Fellowship Information: https://www.gmthub.co.uk/our-programmes/gp-fellowship Links to information about the GP Fellowship, the GP Nurse Fellowship, Primary Care Mentoring and a course for clinicians New to Primary Care: https://www.gmthub.co.uk/our-programmes For Questions about the Fellowship and how it works that aren’t answered in the links above: [email protected] Health Education England GP Fellowships: https://www.nwpgmd.nhs.uk/post-cct-gp-fellowship-programme-hee-nw ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to talk to GP and Professor of General Practice Research Dr Carolyn Chew-Graham about the current landscape of Long COVID three years on. She spoke to us on the topic back in August 2021, but what we know and some of the treatments have moved on from then. In this talk we discuss why the patient-preferred term is Long COVID rather than Post COVID Syndrome, symptoms, how many people are living with the condition in the UK to date and some of the types of management and help that are available.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Your COVID Recovery Website: https://www.yourcovidrecovery.nhs.uk/ Interviews with Patients with Long COVID: https://healthtalk.org/Long-Covid-In-Adults/overview Postural Orthostatic Tachycardia Syndrome: https://www.potsuk.org  https://www.potsuk.org/gp_guide BMJ Article on Orthostatic Tachycardia with Infographic Mentioned (March 2023): https://www.bmj.com/content/378/bmj-2022-072117 Information on Mastocytosis and Mast Cell Activation Syndrome: https://ukmasto.org/#gsc.tab=0 https://www.potsuk.org/about-pots/associated-conditions/mcas/ Greater Manchester Long COVID Support Group: https://hsm.manchester.gov.uk/kb5/manchester/directory/service.page?id=Rn19N5XSimc UK Long COVID Support Group: https://www.longcovid.org/ Support Groups for Families with a Child with Long COVID: https://www.longcovidkids.org/ Advice for Supporting a Child with Long COVID: https://theconversation.com/supporting-a-child-with-long-covid-tips-from-parents-of-children-living-with-the-condition-195153 Research on Impact of Long COVID on Racially Minoritised Groups: https://blog.westminster.ac.uk/hicovestudy/ Research on whether existing Medications have any Impact on Long COVID ‘STIMULATE ICP’: https://www.stimulate-icp.org/ LOCOMOTION Study looking at Optimising Treatments in Long COVID: https://bmjopen.bmj.com/content/12/5/e063505 Be Part of Research: What Trials are available (here for people with Long COVID): https://bepartofresearch.nihr.ac.uk/results/search-results?query=long%20covid&location= National Institute for Health and Care Research: https://www.nihr.ac.uk/patients-carers-and-the-public/i-want-to-take-part-in-a-study.htm Resources around advice for Returning to Work: https://www.som.org.uk/take-planned-approach-managing-long-covid-workforce-new-som-guide  https://www.fom.ac.uk/wp-content/uploads/longCOVID_guidance_04.pdf  https://bjgp.org/content/71/712/508 NICE RCGP SIGN Guidance on Managing Patients with Long COVID (Last Updated Nov 2021): https://www.nice.org.uk/guidance/ng188 RCGP Online eLearning Module on Long COVID: https://elearning.rcgp.org.uk/course/view.php?id=492 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to GP Dr Adam Cliffe about how he and his practice went about changing the model by which patients access the practice. It is so far working very well for both staff and patients. It’s an interesting talk about change management and one example of how a difficult situation was changed for the better.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  House of Commons Committee Report: The Future of General Practice Oct 2022: https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/113/report.html#heading-0 The King’s Fund, Innovative Models for General Practice June 2018: https://www.kingsfund.org.uk/publications/innovative-models-general-practice ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Aseem Mishra, Academic GP trainee involved in helping produce the Guidelines for the Greater Manchester Lipid Pathway. Greater Manchester has very high levels of Major Adverse Cardiovascular Events (MACEs). The guidelines for how to treat hyperlipidaemia and what we’re aiming for have changed. Dr Mishra helps talk through these changes.  Towards the end of the episode, we discuss injectable treatments for secondary prevention including Inclisiran. The resource links are extensive, we hope you find the discussion and the links as useful as we do.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE Clinical Knowledge Summaries for Lipid Modification Jan 2023 (links to both Primary and Secondary Prevention): https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/ Familial Hypercholesterolaemia Assessment Guidelines (links to Simon Broome and the Dutch Lipid Clinic Criteria): https://cks.nice.org.uk/topics/hypercholesterolaemia-familial/diagnosis/assessment-diagnosis/ Statins Prescribing Information, with risks of serious side effects and interactions: https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/prescribing-information/statins/#adverse-effects National Statin Intolerance Pathway: https://www.england.nhs.uk/aac/publication/statin-intolerance-pathway/ Manchester Secondary Prevention Lipid Pathway: https://gmmmg.nhs.uk/wp-content/uploads/2023/02/Lipid-Management-Pathway-for-Secondary-Prevention-of-Cardiovascular-Disease-CVD-21.12.22.pdf GMMMG Prescribing Information for Inclisiran: https://gmmmg.nhs.uk/wp-content/uploads/2022/11/Inclisiran-prescribers-information-leaflet-13.10.22-for-web.pdf SPIRIT Trial on Inclisiran: https://clinicaltrials.gov/ct2/show/NCT04807400 NHS Accelerated Access Collaborative: https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/commercial-partnerships/ Health Innovation Manchester Lipid Webinar and Links to Prescribers and Patient Information for Inclisiran: https://healthinnovationmanchester.com/cvdprevention-lipidpathway-resources/ HeartUK resource on Statins: https://www.heartuk.org.uk/getting-treatment/statins Reference for the discussion on Plaque Regression: Kalanuria A, Nyquist P and Ling G. (2012) The prevention and regression of atherosclerotic plaques: Emerging Treatments Vascular Health Risk Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459726/ Tool to Calculate Lifetime Cardiovascular Disease risk: https://u-prevent.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to ENT Consultant Ms Sadie Khwaja about common throat symptoms we encounter in General Practice and get her take on how to assess and manage these. We cover Red Flag symptoms for the neck in detail as well as looking at three cases we commonly encounter; pain on swallowing, globus symptoms and hoarseness. We discuss a useful approach for assessing causes of throat problems, consider the triad of swallowing, breathing and voice difficulties and the importance of feeling for neck lumps amongst other interesting pearls of wisdom.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE guidelines for Head and Neck Cancer Referrals: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#head-and-neck-cancers Greater Manchester Cancer: Head and Neck Cancer: Homepage: https://gmcancer.org.uk/head-and-neck/ Greater Manchester Cancer: Head and Neck Cancer: 2 week wait Proforma: https://gmcancer.org.uk/wp-content/uploads/2021/10/head-and-neck-referral-form.pdf EAT-10 Swallowing Screening Tool Score: https://www.exservanhcp.com/assets/dist/pdfs/eat-10-screening-tool.pdf Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial. BMJ Jan 2021: https://www.bmj.com/content/372/bmj.m4903 British Voice Association (BVA) resources: https://www.britishvoiceassociation.org.uk/free.htm British Voice Association (BVA) resources: General Voice Care Advice: https://www.britishvoiceassociation.org.uk/downloads/free-voice-care-literature/Take%20care%20of%20your%20voice.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Maiedha Raza to find out her take on issues of Equality and Diversity in General Practice. This is a gentle dive into the very complex world of diversity and inclusivity with messages of how we can improve our culture in the NHS.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Talks by Nancy Kline: Time to Think: https://www.youtube.com/channel/UCNF-NcrXmaOHp1KmLxIuNOw Pulse Article: Over one in five young GPs has experienced racism at work (Jan 2023): https://www.pulsetoday.co.uk/news/workforce/over-one-in-five-young-gps-has-experienced-racism-at-work/ Psychological Safety: https://psychsafety.co.uk/about-psychological-safety/ TED Talk by Amy Edmonson Building a Psychologically Safe Workplace (May 2014): https://www.youtube.com/watch?v=LhoLuui9gX8 British Medical Association Equality and Diversity Guidance: https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance British Medical Association Delivering Racial Equality in Medicine Report (2020): https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/race-equality-in-medicine/delivering-racial-equality-in-medicine NHS leadership Academy Inclusion, Equality and Diversity Resources: https://www.leadershipacademy.nhs.uk/inclusion-equality-and-diversity/ NHS Leadership Inclusivity Course: https://www.leadershipacademy.nhs.uk/programme-course-1-inclusive-leadership-in-health-and-care/ Induction Resources for International Medical Graduates: https://www.e-lfh.org.uk/programmes/nhs-induction-programme-for-international-medical-graduates/#:~:text=The%20National%20Induction%20programme%20has,transition%20to%20UK%20clinical%20practice. TED Talk By Tiffany Alvoid: Eliminating Microaggressions: The Next Level of Inclusion: https://www.ted.com/talks/tiffany_alvoid_eliminating_microaggressions_the_next_level_of_inclusion Professor Camara Jones Talk on Anti-Racism and Health: Levels of Health Intervention (Nov 2022): https://www.youtube.com/watch?v=yEHXVUiUMtU Toolkit: Being an Ally: https://www.imperial.nhs.uk/-/media/website/about-us/how-we-work/equality-and-diversity/allyship-toolkit_14_03.pdf?rev=ff58666cce764881ac223312733c4abb&hash=93DED6E338883958AD0176E3FC130E86 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Sarah Taylor about the changes being made to how Primary Care Clinicians refer patients for Suspected Lower Gastrointestinal Cancers. These changes are discussed in the context of referring in the Greater Manchester area, but you can view the  joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology below.  This will change the way we manage patients. To help, we go through some potential cases. Good tips for how to mitigate potential risks with the changes included. We hope you find this useful. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG): https://www.bsg.org.uk/clinical-resource/faecal-immunochemical-testing-fit-in-patients-with-signs-or-symptoms-of-suspected-colorectal-cancer-crc-a-joint-guideline-from-the-acpgbi-and-the-bsg/ GatewayC FIT infographic: http://bit.ly/409mXUy GatewayC Lower GI infographic: http://bit.ly/3XJpIKN Raised Platelets and Cancer Risk: https://gpnotebook.com/en-au/simplepage.cfm?ID=x2019111783915921223 The Current NICE Guidelines last Updated December 2021: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#lower-gastrointestinal-tract-cancers ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to GP Dr David Bartlett who works with the Neuroendocrine Cancer UK charity and GP Dr Will Evans who is a researcher specialising in rare diseases. We wanted to discuss how they  approach finding rare diseases in General Practice whilst balancing this with the risk of over investigating. We start with definitions and classifications before discussing where neuroendocrine cancers fit into this landscape. Their pearls of wisdom could help us keep our antenae up, referrals helpful and resources for clinicians and patients well stocked.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  British Journal of General Practice Article: Rare diseases in General Practice: Recognising the Zebras among the Horses. Evans, W & Rafi I (Vol 66, 2016): https://bjgp.org/content/66/652/550 Rare Disease UK: https://www.raredisease.org.uk/ Neuroendocrine Cancer UK: https://www.neuroendocrinecancer.org.uk/ Royal College of GPs eLearning on Neuroendocrine Cancers (search here): https://www.rcgp.org.uk/learning-resources/courses-and-events/elearning-courses Medics for Rare Diseases: https://www.m4rd.org/ Information on Beckwith Wiedemann Syndrome: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/beckwith-wiedemann-syndrome-bws/ Inattentional Bias Studies with Radiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964612/ https://pubmed.ncbi.nlm.nih.gov/17412097/ Mnemonic Family GENES Reference: Genetic red flags: clues to thinking genetically in primary care practice. Whelan et al. Primary Care: Clinics in Office Practice (Sept 2006): https://pubmed.ncbi.nlm.nih.gov/15331244/ Resource with helpful leaflets for Chromosomal Diseases: https://rarechromo.org/ OMIM: An Online Catalogue of Human Genes and Genetic Disorders: https://www.omim.org/ Gene Reviews: https://www.ncbi.nlm.nih.gov/books/NBK1116/ Orphanet Rare Disease Platform with Search Engine: https://www.orpha.net Rare Disease Search Engine: https://www.findzebra.com/https://www.ndr-uk.org/browse ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dietician Charlotte Cockman about managing weight for patients who are overweight or obese in General Practice. This includes a discussion around the definitions of overweight and obesity, risk factors, and what terms are less stigmatising when discussing weight with patients. Charlotte talks to us about her approach to weight, eating and health, and how this approach can encourage long term behavioural changes that focus on health and nutrition rather than weight. We discuss management options including what tier two and three NHS services do, as well as where some medications and surgery fit into this picture. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE Clinical Knowledge Summaries Obesity (Sept 2022): https://cks.nice.org.uk/topics/obesity/ Waist to Height Ratio: https://www.nice.org.uk/guidance/cg189/chapter/Recommendations Greater Manchester Diabetes My Way: Healthy Living Support for People with Diabetes: https://diabetesmyway.nhs.uk/ The Association of UK Dieticians Resources: https://www.bda.uk.com/food-health/workplace-health-work-ready/what-we-do/resources.html Giles Yeo Webinar: https://mynutriweb.com/why-calories-dont-count/ Giles Yeo ‘Why Calories don’t count’ Book: https://www.betterworldbooks.com/search/results?q=Giles%20Yeo Giles Yeo: ‘Let’s consider the type of food we eat, not fixate on calories’ The Guardian. David Cox (Jun 2021): https://www.theguardian.com/science/2021/jun/20/giles-yeo-why-calories-dont-count-diet-interview British Dietetic Association Food Resources: https://www.bda.uk.com/food-health/food-facts.html Resources on Weight Stigma: https://www.bda.uk.com/news-campaigns/campaigns/managing-and-preventing-obesity/eliminating-weight-stigma-comms-guidelines.html https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma For Healthcare Professionals interested in more Nutritional Knowledge: https://mynutriweb.com/ Nutrition information leaflets: https://www.ndr-uk.org/browse ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa speak with Christopher Lewis, Operations Learning and Development Manager for Greater Manchester Training Hub. His non-pretentious, passionate approach to coaching and mentoring was infectious. We hope you get a flavour of how coaching and mentoring might help in General Practice. The episode was designed with GP fellows in mind but anyone working in Primary Care may benefit. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Training Hub with Links to the Fellowship Programme and the GP Supporting Mentors Scheme: https://www.gmthub.co.uk/our-programmes If you’re based in Greater Manchester and interested in signing up for coaching/mentoring, you can go to: https://www.gmthub.co.uk/our-programmes or email: [email protected] GROW model for Coaching: https://www.performanceconsultants.com/grow-model Videos of Sir John Whitmore Coaching in action: https://www.coachingcultureatwork.com/sir-john-whitmore/ The Golf coaching video we discussed: https://www.youtube.com/watch?v=Ncb1jjRZyNU Looking After You Too, NHS Wider Primary Care Workforce Coaching Offer: https://www.england.nhs.uk/supporting-our-nhs-people/support-now/looking-after-you-confidential-coaching-and-support-for-the-primary-care-workforce/looking-after-you-too/ How to use a Wheel of Life Coaching Tool: https://www.inside-out-coaching.com/how-to-use-the-wheel-of-life-coaching-tool-to-create-a-balanced-life/#:~:text=The%20Wheel%20of%20Life%20is,and%20I%20mean%20really%20know. Dr Rachel Morris Hosts the You are not a Frog Podcast for GPs and other professionals. The Episodes and her Shapes Toolkit and other resources Involve Coaching: https://youarenotafrog.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Consultant Otolaryngologist Ms Emma Stapleton and Clinical Scientist David Jay about Vertigo. We discuss the definition, differentials, and how to use information around timing and triggers to differentiate between the likely causes of vertigo. We get their take on the important details in the examination that can help identify the diagnosis, and talk options for managing the most common types of peripheral vertigo. The resources section of the episode description contains excellent resources to help, including examples of how to perform and interpret the Head Impulse test, as well as vestibular rehabilitation resources for patients.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE . Nov 2009, Stroke: https://pubmed.ncbi.nlm.nih.gov/19762709/ A summary of HINTS by David Jay: Developments in diagnostic approaches for acutely dizzy patients: (Feb 2020 ENT & Audiology News): https://www.entandaudiologynews.com/features/audiology-features/post/developments-in-diagnostic-approaches-for-acutely-dizzy-patients TiTrATE: A Novel Approach to Diagnosing Acute Dizziness and Vertigo. Newman-Toker and Edlow J A. Neurology Clinics (Aug 2015)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522574/ The Five Deadly D’s of Dizziness (red flags to remember): EM Resident, Unravelling the Mystery of Dizziness in the ED: A Guide for the Student Clerkship, Oct 2018 Wilcox K, Shafer K: https://www.emra.org/emresident/article/dizziness/ BMJ Vertigo: Dix-Hallpike Video: https://www.youtube.com/watch?v=8RYB2QlO1N4 BMJ Vertigo: Epley Manoeuvre Video: https://www.youtube.com/watch?v=jBzID5nVQjk&t=44s Examples of how to perform the Head Impulse Test for Peripheral Vestibular Dysfunction:             https://www.youtube.com/watch?v=psyPED6anPo             https://www.youtube.com/watch?v=XpghlvnrREI Professor Lucy Yardley: Retraining your Balance: https://www.menieres.org.uk/files/pdfs/balance-retraining-2012.pdf VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients:  Main Page: https://vestibular.org/ VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients:  Type of Vestibular Disorders Page: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/ Meniere’s Society UK: https://www.menieres.org.uk/ The Migraine Trust: https://migrainetrust.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa speak with Dr John Patterson about Health Inequalities. This is the second of our two talks on Health Inequalities, please check out Dr Laura Neilson’s talk before this one. Dr John Patterson is a GP and Medical Director of Hope Citadel, as well as their Focused Care Lead and the Chief Clinical Officer for Oldham CCG. We discuss the social determinants of health and a working definition of health inequalities. He talks to us about his journey into tackling health inequalities, his projects, and others of interest. He makes a compelling case as to the importance of health inequalities, and how ‘the right thing is always the smart thing to do’. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Book: Tackling Causes and Consequences of Health Inequalities: A Practical Guide (2020) Edited By James Matheson, John Patterson, Laura Neilson: https://www.routledge.com/Tackling-Causes-and-Consequences-of-Health-Inequalities-A-Practical-Guide/Matheson-Patterson-Neilson/p/book/9781138499867 Hope Citadel Resources: https://hopecitadel.org.uk/ Focused Care (service model to work with the most vulnerable families in communities): https://focusedcare.org.uk/ The Shared Health Foundation: https://sharedhealthfoundation.org.uk/ Greater Manchester Deprivation GP training programme: https://www.docsindepgpst.org.uk/ The Marmot Review 10 Years On: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on?gclid=Cj0KCQjwkt6aBhDKARIsAAyeLJ28cEVgCnGVUAgk9SflEGZnM-Q0iZ76by6yxw7R-T0CktbmSGIqllkaAg9CEALw_wcB Doctors John Patterson and Laura Neilson both mention the Eden Project: https://joineden.org/ Maslow’s Hierarchy of Needs (discussed as an approach to Health): https://www.gp-training.net/communication-skills/communication-skills-theory/maslows-hierarchy-of-needs Professor Steve Fields (Previously NHS England’s Deputy National Medical Director, with the lead responsibility for addressing health inequalities): http://www.homelessnessandhealth.co.uk/events/2017/professor-steve-field/ Interesting Paper Mentioned: North and South: addressing the English health divide, Clare Bambra, Ben Barr, Eugene Milne (2014): https://academic.oup.com/jpubhealth/article/36/2/183/2901779 Related Blog: What can German reunification teach the UK about levelling up? UK policymakers can learn lessons from the German experience to help level up the UK economy Kathrin Enenkel (2021): https://www.centreforcities.org/blog/what-can-german-reunification-teach-the-uk-about-levelling-up/ Common-Wealth health Inequalities Global Research: https://www.common-wealth.co.uk/ David Buck Kings Fund Focused Secondary Prevention in Primary Care is the fastest way to close health inequalities: https://www.kingsfund.org.uk/blog/2011/04/incentivising-public-health-primary-care-learning-qof The Black Report on Health Inequalities in 1980: https://navigator.health.org.uk/theme/black-report-health-inequalities NHS Health Inequalities Oversight Group: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/our-approach-to-reducing-healthcare-inequalities/strategic-drivers/ Core20PLUS5 A national approach to reducing health inequalities explained: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ Bentley C and Leaman J Health Inequalities: National Support Team Priority actions based upon best practice that could impact inequalities in mortality and life expectancy in the short term  (accessed Oct 2022): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215329/dh_130949.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Laura Neilson the founder of Hope Citadel who is passionate about tackling Health Inequalities. She talks to us about the importance of addressing them, what the inverse care law is, and skills that people will find useful working in areas of deprivation. We ask her about her projects which include helping create Hope Citadel; a growing group of practices working in areas of deprivation in Manchester, Focused Care; a project that facilitates this, and the Shared Health Foundation. We ask what we in general practice can do to help, and talk about coping with the challenges. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Book: Tackling Causes and Consequences of Health Inequalities: A Practical Guide (2020) Edited By James Matheson, John Patterson, Laura Neilson: https://www.routledge.com/Tackling-Causes-and-Consequences-of-Health-Inequalities-A-Practical-Guide/Matheson-Patterson-Neilson/p/book/9781138499867 Hope Citadel Resources: https://hopecitadel.org.uk/ Focused Care (service model to work with the most vulnerable families in communities): https://focusedcare.org.uk/ The Shared Health Foundation: https://sharedhealthfoundation.org.uk/ Policy and Advocacy advice from Shared Care Foundation; how to get involved with their projects: https://sharedhealthfoundation.org.uk/policy-and-advocacy/ Greater Manchester Deprivation GP training programme: https://www.docsindepgpst.org.uk/ The Marmot Review 10 Years On: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on?gclid=Cj0KCQjwkt6aBhDKARIsAAyeLJ28cEVgCnGVUAgk9SflEGZnM-Q0iZ76by6yxw7R-T0CktbmSGIqllkaAg9CEALw_wcB The Inverse Care Law explained: https://www.kingsfund.org.uk/publications/articles/inverse-care-law Lives on the Line: Life Expectancy at Birth & Child Poverty as a Tube Map: https://life.mappinglondon.co.uk/ All Party Parliamentary Group for improving the lives of people in Temporary Accommodation across England:  https://householdsintemporaryaccommodation.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with GP Dr Uma Marthi about Endometriosis; a topic she is passionate about due to the common delay in diagnosis, coupled with the impact this condition has on peoples’ lives.  We talk through a hypothetical case and explore differential diagnoses for dysmenorrhoea, examination tips, investigations and management. We discuss the importance and impact of this condition, fertility and the need to think about and treat this as soon as we can. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE Clinical Knowledge Summaries, Dysmenorrhoea: https://cks.nice.org.uk/topics/dysmenorrhoea/ NICE Clinical Knowledge Summaries, Endometriosis: https://cks.nice.org.uk/topics/endometriosis/ All Parliamentary Group on Endometriosis: https://www.endometriosis-uk.org/all-party-parliamentary-group-endometriosis Endometriosis UK: https://www.endometriosis-uk.org/ European Society of Human Reproduction and Embryology Endometriosis Guidelines: https://www.eshre.eu/Guideline/Endometriosis Guardian Article: Endometriosis took my fertility, and part of my self Hilary Mantel (Sept 2015): https://www.theguardian.com/commentisfree/2015/sep/28/endometriosis-fertility-hilary-mantel All Party Parliamentary Group (APPG) on Endometriosis Inquiry Report 2020: https://www.endometriosis-uk.org/sites/default/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf British Society for Gynecological Endoscopy, includes links to Specialist Endometriosis Centres around the UK: https://www.bsge.org.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by Dr Avil Danczak to talk about how we can use consultation skills to improve our time management in General Practice. She takes us through first principles and core skills before talking about common pitfalls and how to avoid them. The principles of all we discuss are elaborated on in the ‘Teaching and Learning Consultation Skills’ (TALC) resources that are available for all to access online in the link below.  Useful resources:  Teaching and Learning Communication Skills Resources: https://www.gmthub.co.uk/talc Mapping Uncertainty in Medicine: What to Do When You Don't Know What to Do? Book By Dr Avril Danczak:  https://uk.bookshop.org/books/mapping-uncertainty-in-medicine-what-to-do-when-you-don-t-know-what-to-do/9780850844054?gclid=CjwKCAjwpqCZBhAbEiwAa7pXeVpSuq3GXdSwdGdHeebuLcrVd0WlMwnAV6qIgQPz9i7ZU2EhKmTk1hoCANIQAvD_BwE You are not a Frog Episode 74: Managing your Time in a System Which Sucks with Dr Ed Pooley: https://youarenotafrog.com/episode-74/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa speak with Consultant Psychiatrist Dr Raja Mukherjee about neurodevelopmental disorders in children. He has an interest in Foetal Alcohol Spectrum Disorder (FASD) and this is the focus of the talk. We cover what neurodevelopmental disorders are, discuss neurodiversity, common disorders such as Autism, ADHD, Dyspraxia aka Developmental Coordination Disorder and Foetal Alcohol Spectrum Disorder.  Useful resources:  NICE Foetal Alcohol Spectrum Disorders: https://www.nice.org.uk/guidance/qs204 My FASD and Me (Foetal Alcohol Spectrum Disorder resource): https://fasd.me/ Foetal Alcohol Syndrome Spectrum Disorder (FASD) Awareness Month Resources including information on the Campaign #Drymester: https://www.drymester.org.uk/resource/fasd-awareness-month-assets/ National FASD trust: https://nationalfasd.org.uk/about-us/who-we-are/ National FASD CPD accredited e-Learning and their website provides expert led advice for GPs and other health care professionals: https://nationalfasd.org.uk/learn-more/training/e-learning/ Greater Manchester based support group for FASD: https://fasdgreatermanchester.co.uk/ Prevention, Recognition and Management of Fetal Alcohol Spectrum Disorders Hardcover – 1 Aug. 2021 by Raja A. S. Mukherjee (Editor), Neil Aiton  (Editor) https://searchworks.stanford.edu/view/13976811 The National Autistic Society: https://www.autism.org.uk/ FASD Book: Strategies not solutions: https://edmontonfetalalcoholnetwork.org/wp-content/uploads/2019/02/strategies_not_solutions_handbook.pdf The Time Is Now Book about Foetal Alcohol Spectrum Disorder: https://nationalfasd.org.uk/wp-content/uploads/2022/03/National-FASD-RT-Report-v004-INTERACTIVE-singles-2.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

*Recorded in June 2020 - Summer Replay* In this episode Lisa and Sara talk to Dr Avril Danczak, a GP with an interest in managing uncertainty in medicine which led to her co-authoring the RCGP published book called Mapping Uncertainty in Medicine. We cover what uncertainty is, and why it is important to address this within medicine and general practice. We talk about ‘what to do when you don’t know what to do’, how to classify and identify different forms of uncertainty and then think about how you can go about addressing and managing this uncertainty in a structured way. Useful resources:  Book: Mapping uncertainty in medicine, what to do when you don’t know what to do; Avril Danczak, Alison Lea and Geraldine Murphy (2016): https://www.amazon.co.uk/Mapping-Uncertainty-Medicine-What-When/dp/0850844053 Paper: Varieties of uncertainty in medicine; Paul Han, William Klein and Neeraj Arora (2011): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146626/ Paper: Dealing with uncertainty in general practice: an essential skill for the general practitioner; Margaret O’Riordan et al: https://pubmed.ncbi.nlm.nih.gov/21781433/ Bradford VTS Resources on decisions, diagnoses and uncertainty: https://www.bradfordvts.co.uk/clinical-skills/decisions-diagnoses-uncertainty/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This week’s episode is designed for primary care clinicians wanting an overview of current diabetes management. Doctors Lisa and Sara are joined by Dr Marlon Morais and Nicola Milne to talk first about Type 1 diabetes briefly (from the GP point of view) before going on to discuss the recent changes to the NICE guidelines for management of Type 2 Diabetes Mellitus. We cover useful ways of sifting through the options for medicines and the importance of a holistic approach and the NHS low calorie programmes. The resource list is incredibly useful. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Visual Summary of NICE Guidelines (Feb 2022): https://www.nice.org.uk/guidance/ng28/resources/visual-summary-full-version-choosing-medicines-for-firstline-and-further-treatment-pdf-10956472093#page=2 Diabetes UK Emotional Wellbeing Module CPD: https://www.diabetes.org.uk/professionals/training--competencies/courses/emotional-wellbeing-module Diabetes on the Net Six Steps to Insulin Safety Module for Healthcare Professionals (based on key recommendations by NICE in 2017): https://diabetesonthenet.com/diabetes-news/six-steps-to-insulin-safety-e-learning-module/ Trend Diabetes Injection Technique Matters: https://trenddiabetes.online/injection-technique-matters/ NICE Clinical Knowledge Summaries: Type 2 Diabetes Mellitus Management for Adults: https://cks.nice.org.uk/topics/diabetes-type-2/management/management-adults/ Diabetes in Control, When and When Not to use an SGLT2 Inhibitor (traffic light system): http://www.northoftyneapc.nhs.uk/wp-content/uploads/sites/6/2021/12/SGLT-2-Top-Tips-V7.pdf SGLT2 inhibitors: Indications, doses and licences from Diabetes & Primary Care: https://diabetesonthenet.com/wp-content/uploads/Brown_Need-to-know-SGLT2is.pdf Diabetes drugs and renal impairment: Updated GPnotebook Shortcuts (Nov 2021): https://diabetesonthenet.com/journal-diabetes-nursing/diabetes-drugs-and-renal-impairment-updated-gpnotebook-shortcuts/ Diabetes on the Net At a Glance Factsheets: https://diabetesonthenet.com/tag/at-a-glance-factsheet/ Diabetes UK: What is a Healthy, Balanced Diet for Diabetes: https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/what-is-a-healthy-balanced-diet The DiRECT Trial: Weight Management Interventions in Type 2 Diabetes Mellitus (informing the Low Calorie Diet Pilots): https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext Sick Day Rules for Type 1 Diabetes Mellitus Leicester: https://static1.squarespace.com/static/5c2ccb867c93271f5edc9718/t/5ed7a143ee2bfa731b017aac/1591189828264/Sick_Day_Rules_T1_Infographic_V4%5B1438%5D.pdf Sick Day Rules for Type 2 Diabetes Mellitus Leicester:  https://static1.squarespace.com/static/5a6439bab7411c94f2ebe216/t/6000117d2a88fe77419f655a/1610617215447/Sick_Day_Rules_T2DM.pdf NHS Very Low Calorie Diets: https://www.england.nhs.uk/diabetes/treatment-care/low-calorie-diets/https://preventing-diabetes.co.uk/know-your-risk-dtc/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by Diabetes Lead for Manchester CCG GP Dr Marlon Morais and Diabetes Support Lead and Diabetes Specialist Nurse Nicola Milne to discuss diagnosis of Diabetes Mellitus. We go through the types of Diabetes Mellitus, touching on MODY and LADA and get advice on avoiding common pitfalls in making a new diagnosis of Diabetes in General Practice. We talk about the prevalence and importance of this diagnosis, both for patients and the NHS and red flags to look out for. We then cover impaired fasting glucose and the current management options for this including the NHS Diabetes Prevention Programme.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Diabetes UK: types of Diabetes Mellitus explained: https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes WHO Classification of Diabetes Mellitus (2019): https://www.who.int/publications/i/item/classification-of-diabetes-mellitus GP Notebook Clinical Classification of Diabetes Mellitus (2021): https://gpnotebook.com/en-gb/simplepage.cfm?ID=-26542064 What is MODY Maturity-Onset Diabetes of the Young?: https://www.diabetesgenes.org/what-is-mody/ NICE guidelines: When to suspect Type 2 Diabetes Mellitus (April 2022): https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/ NICE CKS Guidelines Type 1 Diabetes Mellitus (Nov 2020): https://cks.nice.org.uk/topics/diabetes-type-1/ Language Matters in Diabetes: https://www.england.nhs.uk/publication/language-matters-language-and-diabetes/ Diabetes UK Information Prescriptions: https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/information-prescriptions-qa Finish Diabetes Prevention Study (2003): https://diabetesjournals.org/care/article/26/12/3230/21849/The-Finnish-Diabetes-Prevention-Study-DPS National Diabetes Prevention Programme: https://www.england.nhs.uk/diabetes/diabetes-prevention/ Flatbush Diabetes information on GP Notebook:  https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20160928141517439169 Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study (Apr 1997): https://diabetesjournals.org/care/article/20/4/537/22408/Effects-of-Diet-and-Exercise-in-Preventing-NIDDM The Da Qing IGT and Diabetes Study 30 year follow up: Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol. Jun 2019: https://pubmed.ncbi.nlm.nih.gov/31036503/ NHS Diabetes Prevention Programme: Know Your Risk Patient Calculator: https://preventing-diabetes.co.uk/know-your-risk-dtc/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara welcome Consultant Haematologist Dr Chris Gregory back to the podcast to discuss bruising and bleeding issues. We go through history, examination and differentials including patterns of bleeding more associated with different causes. We cover what constitutes excessive/concerning bleeding and blood test values that would lead to on the day/urgent referrals. At the end of the episode, you will hear our learning points. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Clinical Knowledge Summaries: Bruising (March 2021) https://cks.nice.org.uk/topics/bruising/ BMJ article Survey, Vitamin C deficiency as a cause of bruising: https://www.bmj.com/content/375/bmj.n2511.full NICE Suspected Cancer Referrals for Haematological Malignancies (as of Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#haematological-cancers Greater Manchester Safeguarding Guidelines for Bruising in Non-mobile Children: https://greatermanchesterscb.proceduresonline.com/chapters/pr_bruising_babies_child.html British Society for Haematology Guidelines: https://b-s-h.org.uk/guidelines/ Non UK based Information: American Family Physician Feb 2016 ‘Clinical evaluation of bleeding and bruising in primary care’. Includes a helpful breakdown of normal vs excessive bleeding etc: https://www.aafp.org/afp/2016/0215/p279.html ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara were thrilled to welcome Professor Dame Helen Stokes-Lampard onto the podcast to talk about one of her passions within medicine - social prescribing. They discuss what social prescribing is and why it matters. They talk about the National Academy of Social Prescribing, and its current roles and remit. There are some great examples shared about social prescribing in action, and resources highlighted where people can find out more information about getting involved and having social prescribing link workers in practice. Useful resources:  Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk NHS England - Social Prescribing: https://www.england.nhs.uk/personalisedcare/social-prescribing/ Academy of Medical Royal Colleges: https://www.aomrc.org.uk/ National Academy for Social Prescribing: https://socialprescribingacademy.org.uk/ National Academy for Social Prescribing Twitter: https://twitter.com/NASPTweets Global Social Prescribing Alliance: https://www.gspalliance.com/ Men’s Sheds: https://menssheds.org.uk/ The Money and Pensions Service: https://moneyandpensionsservice.org.uk/ Park Run: https://www.parkrun.org.uk/ English National Opera - Breathe: https://www.eno.org/eno-breathe-3/ Campaign to End Loneliness: https://www.campaigntoendloneliness.org/ Football Association - Walking Football: https://thewfa.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Today Lisa and Sara welcome Dr Rachel Morris back onto the podcast. Rachel is a former GP who has previously worked in GP education. She is now an executive coach and host of the wonderful podcast You Are Not a Frog. The discussion in this episode is all about assertiveness - we chat about what assertiveness is, general tips, frameworks and models for how to approach assertiveness, as well as showcasing how these can work with a few examples. Useful resources:  Looking after Yourself in General Practice (previous Primary Care Knowledge Boost episode): https://www.pckb.org/e/looking-after-yourself-in-general-practice/ To Sign Up to the Shapes Toolkit mailing list and get a free Zone of Power handout as well as being notified when their brand new mini video series is released in a couple of weeks: https://www.shapestoolkit.com/zone-of-power Check out the You Are Not A Frog podcast: www.youarenotafrog.com Find out more about Rachel’s CPD community for doctors: www.permissiontothrive.org Find out more about the Resilient Team Academy online membership for busy leaders in healthcare: https://www.shapestoolkit.com/resilient-team-academy Get in touch with Rachel: [email protected] Find out more about her training: www.shapestoolkit.com Sign up for your FREE mini video series training from Rachel, all about setting boundaries and saying no https://www.shapestoolkit.com/boundaries Thomas–Kilmann Conflict Mode Instrument: https://kilmanndiagnostics.com/overview-thomas-kilmann-conflict-mode-instrument-tki/ NonViolent Communication Model by by Marshall B. Rosenberg: https://www.nonviolentcommunication.com/learn-nonviolent-communication/4-part-nvc/ Dr. Rangan Chatterjee Podcast, Feel Better Live More: How to Build Exceptional  Relationships and Why You Should with David Bradford and Carole Robin: https://drchatterjee.com/how-to-build-exceptional-relationships-and-why-you-should-with-david-bradford-and-carole-robin/ Connect: Building Exceptional Relationships with Family, Friends and Colleagues by David L. Bradford and Carole Robin: https://www.penguin.co.uk/books/314/314545/connect/9780241986868.html ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is another episode with a focus on Urology. Doctors Lisa and Sara invited Professor Ian Pearce back to speak about overactive bladder and urinary incontinence in women. They discuss the types of lower urinary tract symptoms in women (drilling down into the definitions of commonly used terms), before looking at the red flags to consider. They then use fictional cases to illustrate how to approach overactive bladder and incontinence in terms of assessment, investigation and management options.  Useful resources:  NICE CKS: Urinary incontinence in women: https://cks.nice.org.uk/topics/incontinence-urinary-in-women/ GMMMG Guidelines for assessment and treatment of overactive bladder in adults: https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf Conservative management tips: Bladder and Bowel Community UK: https://www.bladderandbowel.org/bladder/bladder-treatments/urinary-tract-infection-treatments/ Guidelines in Practice: Top tips: urinary incontinence in women: https://www.guidelinesinpractice.co.uk/urology/top-tips-urinary-incontinence-in-women/455577.article Anticholinergic Burden resource 2: Anticholinergic Burden Calculator: http://www.acbcalc.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak to Judith Dawson to learn all about the ins and outs of supervising the Additional Roles Reimbursement Scheme members as the landscape stands at the moment. They discuss who can be a supervisor, the training involved and what that might mean for the day job.  Useful resources:  Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf GP mythbuster 106: Primary care first contact practitioners (FCPs), Care Quality Commission: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbuster-106-primary-care-first-contact-practitioners-fcps Integrating additional roles into primary care networks, The King's Fund: https://www.kingsfund.org.uk/publications/integrating-additional-roles-into-primary-care-networks ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is another episode in the series looking at all of the different roles that exist within primary care. Doctors Lisa and Sara speak to Charlotte Cockman who is a Dietician working in Primary Care in South Manchester.  They discuss what a Dietician is and what the role can look like in Primary Care. It’s a new role and can be tailored to best suit the community. They also cover what the training consists of, what the day job looks like and advice for clinicians in Primary care around brief discussions with patients on nutrition. The discussion ends with some quick fire questions around supervision, opportunities for further professional development and registration requirements Useful resources:  Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Sara and Lisa tackle another urology topic today - recurrent urinary tract infections (UTIs) in non-pregnant women. They speak to Ian Pearce who is a consultant urologist at Manchester Royal Infirmary. They discuss what UTIs are, and what makes them recurrent vs relapsing. They also chat through how to assess someone with recurrent UTIs and highlight some of the risk factors, before talking about the red flags for more sinister causes. The management options for recurrent UTIs are also covered, from conservative options to medications, including a detailed dive into antibiotic prophylaxis. They also get Ian’s opinions on who to refer to urology. Useful resources:  Conservative management tips: Bladder and Bowel Community UK: https://www.bladderandbowel.org/bladder/bladder-treatments/urinary-tract-infection-treatments/ NICE Recurrent UTI Guidelines (Published Oct 2018): https://www.nice.org.uk/guidance/ng112 Guidelines in Practice: The diagnosis and management of uncomplicated recurrent urinary tract infection (March 2019): https://www.guidelines.co.uk/urology/uncomplicated-recurrent-uti-guideline/454623.article GMMMG Antibiotic Prescribing Guidelines (last updated Oct 2021): https://gmmmg.nhs.uk/wp-content/uploads/2021/10/GM-Antimicrobial-guidelines-OCT-2021-v10.0.pdf BMJ article: Methenamine hippurate for recurrent urinary tract infections, published on 9/3/22 (after episode was recorded): https://www.bmj.com/content/376/bmj.o533 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

****DISCLAIMER - CONTAINS STRONG LANGUAGE**** Doctors Lisa and Sara talk with GP Dr Austin O'Carroll. Austin works in Inner-City Dublin with marginalised and homeless/rough sleeping communities. He is co-founder of Safetynet Ireland, North Dublin City GP Training, and GPCareForAll. He talks to us about his take on how unhelpful the label of personality disorder is for patients in his care, about his take on the situation: the Triple F**k syndrome, and how medicine contributes to the systemic oppression of people born into poverty. We talk about trauma informed care and examples of outcomes for patients in his care.  Useful resources:  Dr Austin O'Carroll's TED talk about developing health services for homeless people (July 2017): https://www.youtube.com/watch?v=GiwRSPY_JqI Safetynet Ireland Charity: https://www.primarycaresafetynet.ie/ GPCareForAll: https://www.gpcareforall.org/our-story BJGP Article: The Triple F**k Syndrome: How medicine contributes to the systemic oppression of people born into poverty (Jan 2022): https://bjgplife.com/the-triple-fk-syndrome-how-medicine-contributes-to-the-systemic-oppression-of-people-born-into-poverty/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk with Consultant Urologist Dan Burke about Lower Urinary Tract Symptoms in Men. We start with how to divide symptoms into voiding and storage. Red flags to consider are discussed, before tackling cases that lead us to talk about bladder diaries, tips for assessing the prostate and how PSA discussions have changed since the introduction of MRI scans and transperineal prostate biopsies. In discussing the thorny subject of prostate cancer and best treatment choices for individuals, we talk about radical treatment, advanced disease and the difference between watchful waiting and active surveillance. Though we talk about men, it is well worth mentioning these symptoms will apply to all people with a prostate including trans women and some non-binary people. Useful resources:  NICE Clinical Knowledge Summaries (Updated March 2019): https://cks.nice.org.uk/topics/luts-in-men/ Guidelines in Practice (2014): Full assessment is key for men with lower urinary tract symptoms: https://www.guidelinesinpractice.co.uk/mens-health/full-assessment-is-key-for-men-with-lower-urinary-tract-symptoms/341437.article Urinary Frequency Charts to assess bladder volume, polyuria and nocturia: https://bladdermatters.co.uk/downloads/85923fchart.pdf LUTS in Men Tower Hamlets NHS guidelines (2012) includes patient information sheets: https://www.qmul.ac.uk/blizard/ceg/media/blizard/images/documents/Lower-Urinary-Tract-Symptoms-in-Men,-Care-Pathway,-January-2012.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This episode is part 2 of our focus on Quality Improvement. This time Drs Lisa and Sara are joined by Dr Varshini Rajakulendran alongside Dr Joanna Bircher. Varshini is a GP who is on the NHS England fellowship, and she talks to us about a quality improvement example that she is currently working on around weight management. Joanna (our resident QI expert) has a passion for the subject and has been involved in writing guidelines and teaching for QI.  We hear why Varshini chose this particular project, and the context to it including enablers and barriers. Joanna then helps us break it down further, thinking about the tool used, considering the aim of the project, what was and could be measured and what ideas were implemented and tested during the project.  If you haven’t already, we recommend listening to “An Introduction to Quality Improvement” which provides some great initial theoretical knowledge about QI. Useful resources:  Quality Improvement Resources by the Royal College of General Practitioners: https://www.rcgp.org.uk/clinical-and-research/our-programmes/quality-improvement/quality-improvement-guide-for-general-practice.aspx RCGP QI Ready: https://qiready.rcgp.org.uk/ Domains of Healthcare Quality: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/DefiningQualityAimingforaBetterHealthCareSystem.aspx Public Health England National General Practice Profiles: https://fingertips.phe.org.uk/profile/general-practice/data#page/8/gid/2000005/pat/166/par/E38000220/ati/7/are/M85736/yrr/1/cid/4/tbm/1  GP Patient Survey data: https://www.gp-patient.co.uk/ Prescribing data: https://openprescribing.net/ Institute for Healthcare Improvement (IHI) Model for Improvement: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx  The Health Foundation booklet: Quality Improvement made simple, written by Bryan Jones, Esther Kwong and Will Warburton: https://www.health.org.uk/sites/default/files/QualityImprovementMadeSimple.pdf RCGP Quality Improvement Webcast with Dr Joanna Bircher Aug 2019: https://youtu.be/BJSbvu3j0cE The Q Community Webcast: ‘Can QI help us to match capacity and demand in General Practice with Dr Joanna Bircher’: https://www.youtube.com/watch?v=RS-GMMZgbfw Run Chart Tool: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/A-guide-to-creating-and-interpreting-run-and-control-charts.pdf  ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is another episode in the series looking at all of the different roles that exist within primary care. Lisa and Sara speak to Heidi West who is a nursing associate as well as an apprenticeship facilitator for nursing associates, and Marina Khan who is a trainee nursing associate.  They discuss what a nursing associate is and how they differ from health care assistants and nurses. They also cover what the training consists of, and the day job and remit of a nursing associate. The discussion ends with some quick fire questions around supervision, opportunities for further professional development and registration requirements. Useful resources:  Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk University of Salford Nursing Associate Programme: https://www.salford.ac.uk/courses/degree-apprenticeship/nursing-associate-nursing-associate-higher-apprenticeship A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf Nursing and Midwifery Council: Nursing Associates Information: https://www.nmc.org.uk/about-us/our-role/who-we-regulate/nursing-associates/ Information on Career Development for Nursing Associates: https://www.healthcareers.nhs.uk/explore-roles/nursing/roles-nursing/nursing-associate ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Joining doctors Lisa and Sara on today’s episode are GP and Perinatal Mental Health Champion Dr Carrie Ladd and Perinatal Psychiatrist Dr Sarah Jones. We discuss types of mental illness that can be experienced in the perinatal period and the challenges in primary care when helping patients and families. We cover tips for addressing these challenges, focusing on communication, resources and managing medications. We also talk about the impact of the pandemic and the Spotlight programme for disseminating perinatal mental health teaching and training trainers. Useful resources:  RCGP Perinatal Mental Health toolkit: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/perinatal-mental-health-toolkit.aspx  Best Use of Medicines in Pregnancy ‘Bumps’ website: https://www.medicinesinpregnancy.org/ The Lancet Series on Perinatal Mental Health (2014): https://www.thelancet.com/series/perinatal-mental-health NICE Guidance on antenatal and postnatal mental health: clinical management and service guidance: https://www.nice.org.uk/guidance/cg192 Proud 2 b Parents Organisation: https://www.proud2bparents.co.uk/ Dad Matters Organisation: https://dadmatters.org.uk/ The Dad Pad, advice for new fathers: https://thedadpad.co.uk/ First 1001 days movement: https://parentinfantfoundation.org.uk/1001-days/ Action on Postpartum Psychosis Charity: https://www.app-network.org/ Maternal Mental Health Alliance Charity: https://maternalmentalhealthalliance.org/ Tommy's Trust: https://www.tommys.org/ Maternal OCD Organisation: https://maternalocd.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara are joined by GP Dr Nikesh Vallabh, Consultant Cardiologist Dr Karthikeyan and Consultant Gastroenterologist Dr Bliss to discuss advice and guidance. For those unfamiliar, the advice and guidance system came about to try to ease pressure on the long outpatient waiting lists, providing a different way of managing some cases. It is in place for a number of specialties for primary care clinicians to ask questions to consultants, getting an answer that will help guide patient care within a matter of short weeks at most. We talk about the system and where it can fit in to make a difference to patient care. We take the opportunity to go through some common themes and glean learning points from these to help our own practice. Useful resources:  Wigan, Wrightington and Leigh have their own LFTs guideline that should be available on the intranet or contact the local CCG BMJ LFTs Algorithm 2017: https://www.bsg.org.uk/wp-content/uploads/2019/12/Guidelines-on-the-management-of-abnormal-liver-blood-tests.pdf Greater Manchester Guidelines for managing patients with dyspepsia in primary care: https://gpexcellencegm.org.uk/resources/guidelines-for-managing-patients-with-dyspepsia-in-primary-care/#.YFEP4C2l23U NICE guidelines Chronic Heart Failure in Adults: Diagnosis and Management (2018) https://www.nice.org.uk/guidance/ng106 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara welcome Dr Joanna Bircher back to the podcast to speak about an area which she is very passionate about - Quality Improvement.  We talk about what quality improvement is, how it differs from audits and why it’s so important within general practice. We also learn about the processes that can be followed when approaching quality improvement, and some helpful tools and tips to think about before you start. We hope it’s accessible for all within general practice, and think it provides a great starting point for those considering quality improvement within their setting. Useful resources:  Quality Improvement Resources by the Royal College of General Practitioners: https://www.rcgp.org.uk/clinical-and-research/our-programmes/quality-improvement/quality-improvement-guide-for-general-practice.aspx RCGP QI Ready: https://qiready.rcgp.org.uk/  Domains of Healthcare Quality: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/DefiningQualityAimingforaBetterHealthCareSystem.aspx Public Health England National General Practice Profiles: https://fingertips.phe.org.uk/profile/general-practice/data#page/8/gid/2000005/pat/166/par/E38000220/ati/7/are/M85736/yrr/1/cid/4/tbm/1  GP Patient Survey data: https://www.gp-patient.co.uk/  Prescribing data: https://openprescribing.net/  Institute for Healthcare Improvement (IHI) Model for Improvement: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx  The Health Foundation booklet: Quality Improvement made simple, written by Bryan Jones, Esther Kwong and Will Warburton: https://www.health.org.uk/sites/default/files/QualityImprovementMadeSimple.pdf RCGP Quality Improvement Webcast with Dr Joanna Bircher Aug 2019: https://youtu.be/BJSbvu3j0cE The Q Community Webcast: ‘Can QI help us to match capacity and demand in General Practice with Dr Joanna Bircher’: https://www.youtube.com/watch?v=RS-GMMZgbfw Run Chart Tool: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/A-guide-to-creating-and-interpreting-run-and-control-charts.pdf  ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.  

Drs Lisa and Sara talk to Dr Luke Wookey, Dr Joanna Bircher and Ava Bircher for an introduction to Trans and Non-Binary Health in General Practice. We start with all important definitions, which leads us to talking about coding, healthcare records and a discussion about screening and health inequalities. We talk about how our practices and consultations can be welcoming, before considering Hormone Replacement Therapy and NHS funded surgical options which are potential options for people accessing Gender Clinics. We move onto health issues that disproportionately affect Trans and Non-Binary people, and discuss important resources for clinicians and patients. A lot more could be said but we hope you will find this a useful resource for the whole Primary Care Team to access.  Useful resources:  LGBT Foundation including links to Pride in Practice: https://lgbt.foundation/ GMC ethical guidelines: Your rights as lesbian, gay, bi and trans patients: https://www.gmc-uk.org/Ethical-guidance/Patient-guides-and-materials/LGBT-patient-guide?utm_source=press&utm_medium=press%20release&utm_campaign=LGBT Royal College of General Practitioners Transgender Care: https://www.rcgp.org.uk/policy/rcgp-policy-areas/transgender-care.aspx TransActual UK: Supporting trans patients: A brief guide for GP surgery staff (excellent resource and links): https://www.transactual.org.uk/gp-surgery-trans Information for trans and non-binary patients seeking fertility treatment: https://www.hfea.gov.uk/treatments/fertility-preservation/information-for-trans-and-non-binary-people-seeking-fertility-treatment/ Changing Name Greater Manchester LMC Guidance: https://manchesterlmc.co.uk/wp-content/uploads/2016/06/LGBT-Foundation-changing-a-trans-persons-name.pdf Changing Name and Gender, Primary Care Support England Flow Diagram: https://pcse.england.nhs.uk/media/1291/process-for-registering-a-patient-gender-re-assignment.pdf Greater Manchester Indigo Gender Service: https://indigogenderservice.uk/ Gender Identity Research and Education Society (includes eLearning packages): https://www.gires.org.uk/ The World Professional Association of Transgender Health: https://www.wpath.org/ The Royal College of General Practitioners Gender Variance eLearning module: https://elearning.rcgp.org.uk/course/search.php?search=transgender Mutual Aid Resource for trans and non binary people in Greater Manchester: https://www.consortium.lgbt/member-directory/trans-mutual-aid-manchester/ Information about Hate Crimes, reporting them and third party Hate Crime centres: https://www.report-it.org.uk/home ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.  

Lisa and Sara speak to Sam Howard, who is an advanced clinical practitioner in primary care. She talks us through her career journey to date and what her job looks like now, as well as highlighting the varied role of an advanced clinical practitioner. She also explains details about supervision, registration and training requirements. This episode was supported by Greater Manchester Training Hub. Useful resources:  Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This episode is another of our lovely chats with wider members of the primary care team. Today Lisa and Sara speak to Vishika Rabadia, a senior pharmacist who is working in primary care in a PCN and CCG pharmacist role. She gives insights into the varied roles of a pharmacist within primary care, the training, and what the supervision and registration side entails. She also provides great examples of some of the work that she has been involved with in her PCN. This episode was supported by Greater Manchester Training Hub. Useful resources:  The National Pharmacy Association (NPA): https://www.npa.co.uk/ Primary Care Pharmacy Education Pathway: https://www.cppe.ac.uk/career/pcpep/pcpep-training-pathway General Pharmaceutical Council: https://www.pharmacyregulation.org/ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk Community Pharmacist Consultation Service (CPCS): https://www.england.nhs.uk/primary-care/pharmacy/community-pharmacist-consultation-service/ Royal Pharmaceutical Society: https://www.rpharms.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Working in General Practice can be challenging at the best of times, but needless to say has been more challenging of late.  Lisa and Sara are joined by Dr Rachel Morris; GP, coach and host of You are not a Frog Podcast. She talks us through her top tips for looking after yourself in general practice. These include: the importance of framing this discussion with the caveat of not teaching ourselves how to put up with toxic work environments, but to consider how we can take control over things that we do have some control over. We discuss the importance of prioritising, planning your week, doing your best work at the best time and consider the importance of ‘catching the story that you’re telling yourself’. We then consider coping with the negativity in the media about general practice at the moment, assertiveness and the difference between stress and burnout. This episode was supported by Greater Manchester Training Hub NHSE GP Fellowship programme.  Useful resources:  Greater Manchester Training Hub NHSE GP Fellowship information: https://www.gmthub.co.uk/offers/gp-fellowship Dr Rachel Morris’s Podcast and Wellbeing/Resilience resources: https://youarenotafrog.com/ NHS Practitioner Help: https://www.practitionerhealth.nhs.uk/ Book recommendation: ‘Essentialism: The Disciplined Pursuit of Less’ by Greg McKeown https://uk.bookshop.org/books/essentialism-the-disciplined-pursuit-of-less/9780753558690 Book Recommendation: ‘The 7 Habits of Highly Effective People’ By Stephen Covey https://uk.bookshop.org/books/the-7-habits-of-highly-effective-people/9780762408337 Permission to Thrive monthly Webinars for doctors: https://www.shapestoolkit.com/permission-to-thrive Resilient Team Academy - membership for leaders in Healthcare to help team to beat burnout and work happier: https://www.shapestoolkit.com/resilient-team-academy-2021 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester training hub, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Back by popular demand, Consultant Neurologist Dr Matt Jones joins us to share his approach to assessing patients with peripheral paraesthesia. Patients don’t present with textbook terms. Dr Matt Jones takes us through how to de-code tingling, numbness and burning, and take a structured approach to these often difficult presentations. We cover the high value examination findings that could help us clinch the diagnosis and put his approach to the test with some theoretical cases.  Useful resources:  A resource for clinicians and patients around Functional Neurological Disorder: https://www.neurosymptoms.org/en_GB/ An example of a link to buy a 128 Hertz Tuning fork: https://www.amazon.co.uk/Gardiner-Brown-128Hz-Vibration-Tuning/dp/B005GZ1RG0/ref=dp_prsubs_2?pd_rd_i=B005GZ1RG0&psc=1 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined again by the lovely Dr Rachel Hilton, who is a speciality doctor in Dermatology. In this episode she takes us through psoriasis - what it is, differentials to consider and associated triggers and comorbidities. She then systematically talks about the management of psoriasis, how this might need to be amended for pregnant patients, and her thoughts about referral indications. Useful resources:  British Association of Dermatologists: https://www.bad.org.uk/   Primary Care Dermatology Society:  www.pcds.org.uk Derm Net NZ: www.dermnetnz.org Psoriasis Association: www.psoriasis-association.org.uk Psoriasis and Psoriatic Arthritis Alliance, PAPAA: www.papaa.org IMPACT study information: https://www.researchgate.net/publication/288833029_The_IMPACT_Programme_in_Psoriasis_Phase_I_-_where_we_are_now_and_future_directions ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Speciality Doctor Rachel Hilton joins us on the podcast to talk about eczema. You’ll hear from the episode that she is passionate about getting the basics right as a way of providing vastly better care to our patients. In the episode we cover: what eczema is, types of eczema and some important differentials, before focusing on the management of atopic eczema. This includes navigating emollients, steroids and calcineurin inhibitors with advice on how to use these effectively.  Useful resources:  Primary Care Dermatology Society: www.pcds.org.uk DermNet New Zealand: www.dermnetnz.org GMMMG Emollient Guidelines: www.gmmmg.nhs.uk/docs/guidance/GM-Emollient-Ladder.pdf GMMMG Steroid Ladder: www.gmmmg.nhs.uk/docs/guidance/GM-Steroid-Ladder.pdf BATHE Study: https://www.rcgp.org.uk/clinical-and-research/about/clinical-news/2019/november/rcgp-research-paper-of-the-year-2018-the-bathe-study.aspx BATHE study BMJ resources: https://www.bmj.com/content/361/bmj.k1332 Recommended resource for patients or parents: National Eczema Society: www.eczema.org ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Originally recorded in January 2020 and released in August 2020... Early diagnosis of cancer is a huge priority in order to try to improve our cancer survival rates in the UK. Lisa and Sara took the opportunity to speak to Dr Sarah Taylor, GP in Fallowfield and Cancer Research UK Cancer Diagnosis Lead for Greater Manchester about this important subject. It was recorded pre-Covid-19 and so some of the information given about services might have changed in your local area. We thought the general tips about picking up cancer as early as possible were incredibly useful however which is why we decided to release the episode.  We cover why early diagnosis of cancer is a priority for the UK, learning points/common themes picked up from significant events in delayed cancer diagnosis, tools that we can use in primary care to help our pick up rate and useful resources for primary care. Useful resources:  Gateway C: https://www.gatewayc.org.uk/ Cancer Research UK Health Professional Section: https://www.cancerresearchuk.org/health-professional Macmillan Health Professional Resources: https://www.macmillan.org.uk/about-us/health-professionals/resources QCancer Score: https://www.qcancer.org/ Cancer Research UK Facilitator Programme: https://www.cancerresearchuk.org/health-professional/learning-and-support/about-our-partnerships/what-is-the-facilitator-programme NICE Suspected cancer - recognition and referral: https://www.nice.org.uk/guidance/ng12 BJGP - Improving early diagnosis of cancer in UK general practice: https://bjgp.org/content/67/659/276 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GP and Professor of General Practice Research Carolyn Chew Graham about Long COVID. We discuss what Long COVID is, its prevalence, and how to assess and manage those presenting with symptoms of possible Long COVID in primary care. We also talk about the condition in children, Long COVID clinics, and how to support patients on this still very new journey. Hopefully this episode will help support learning for the new Long-COVID enhanced service that has recently been launched by NHS England. ___ NICE COVID-19 rapid guideline: managing the long-term effects of COVID-19 [NG188] Published: 18 December 2020: https://www.nice.org.uk/guidance/ng188 The Post-hospitalisation COVID-19 study (PHOSP-COVID): https://www.phosp.org/ British Thoracic Society Resources for the respiratory Community about COVID-19 (includes advice on chest x-rays and COVID): https://www.brit-thoracic.org.uk/covid-19/covid-19-information-for-the-respiratory-community/ Your COVID recovery resource: https://www.yourcovidrecovery.nhs.uk/app/ Long COVID SOS support group for patients: https://www.blf.org.uk/support-for-you/long-covid UK Doctors with Long COVID Facebook Group: https://www.facebook.com/groups/479687042869493/ BJGP Open Article: Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID 2020: 4(5) Kingstone T, Taylor AK, O'Donnell CA, Atherton H, Blane DN and Chew-Graham CA: https://bjgpopen.org/content/4/5/bjgpopen20X101143 Health Expectations Article: 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID (Mar 2021) Taylor AK, Kingstone T, Briggs TA, O'Donnell CA, Atherton H, Blane DN, Chew-Graham CA: https://onlinelibrary.wiley.com/doi/10.1111/hex.13223 The Royal College of General Practitioners online learning module on Long COVID: https://elearning.rcgp.org.uk/course/view.php?id=492 Article, The Conversation: Aiyegbus OL, Haroon S, (July 2021) Long COVID: symptoms experienced during infection may predict lasting illness: https://theconversation.com/long-covid-symptoms-experienced-during-infection-may-predict-lasting-illness-164649?utm_source=twitter&utm_medium=bylinetwitterbutton ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This episode is another of our lovely chats with wider members of the primary care team. Today Lisa and Sara speak to Laura Butroid, a pharmacy technician who is working in primary care. She gives insights into the varied roles of a pharmacy technician within primary care, and how this differs from a pharmacist. She also discusses what the training looks like and what the supervision and registration side entails. ___ The National Pharmacy Association (NPA): https://www.npa.co.uk/ Buttercups Integrated Level 3 Cross Sector Programme: https://www.buttercupstraining.co.uk/news/buttercups-launches-new-level-3-pharmacy-technician-integrated-programme Primary Care Pharmacy Education Pathway: https://www.cppe.ac.uk/career/pcpep/pcpep-training-pathway General Pharmaceutical Council: https://www.pharmacyregulation.org/ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk HEE Medicines optimisation: https://hee.nhs.uk/our-work/medicines-optimisation ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined by Dr Amar Rughani and Dr Joanna Bircher to discuss team working in the context of leadership.  We focus on specific examples of some potential conflicts within the primary care team such as when members of a team do not get on and how to manage interruptions of a surgery. ___ Amar Rughani and Joanna Bircher (2020): The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984 Hersey, P & Blanchard KH (2002). Management of Organizational Behaviour: Utilising Human Resources. Classiquese Hachette. https://www.goodreads.com/book/show/349881.Management_of_Organizational_Behavior Tuckman, B (1965). Team Building Theory, paraphrased here: https://www.teambuilding.co.uk/theory/Forming-Storming-Norming-Performing.html West, M A (2012). Effective Teamwork: Practical Lessons from Organizational Research. John Wiley & Sons and the British Psychological Society. https://www.wiley.com/en-gb/Effective+Teamwork%3A+Practical+Lessons+from+Organizational+Research%2C+3rd+Edition-p-9780470974988 Podcast: The Happiness Lab with Dr Laurie Santos https://www.happinesslab.fm/ ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to practice managers Amanda Ormesher and Karen Bradshaw about the role of the practice manager in general practice.  This is a great episode to find out more about the role and how varied it is.  We go through what a practice manager is, the different remits of practice managers and some learning points about the role for new staff coming into primary care. Their passion and dedication are uplifting to hear. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Occupational Therapist and Advanced Clinical Practitioner Payal Wilson about the role of occupational therapists in primary care. She talks about how to become an occupational therapist, the training involved, and how occupational therapists might work in primary care (their remit and the roles they could take on). She also discusses her current career, the advantages of occupational therapists in advanced clinical practitioner roles, and considerations (including supervision) for occupational therapists when working in primary care as part of the additional roles reimbursement scheme (ARRS). ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Geriatrician Dr Emma Vardy & GP Dr Helen Martin all about Delirium. If we pick delirium up early and treat the right cause it can make a world of difference to patients and families. They share some great tips on how to diagnose and remember the list of causes. We also discuss the Greater Manchester delirium toolkit which was developed for use in the community to act as a framework for assessment and management of delirium. ___ Greater Manchester Community Delirium Toolkit: https://dementia-united.org.uk/delirium-community-toolkit/ Dementia United (Greater Manchester based): https://dementia-united.org.uk/ Delirium NICE Clinical Knowledge Summaries: https://cks.nice.org.uk/topics/delirium/#!goals Scottish SIGN Guidelines, SIGN 157, Risk reduction and management of delirium: https://www.sign.ac.uk/media/1423/sign157.pdf ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional

In this episode Lisa and Sara discuss the topic of Primary Care Networks with Vicky Tolliday (Nurse, Director of the social enterprise “Better Health Manchester”, and Clinical Director of a Primary Care Network), and Dr Girish Patel (GP and Clinical Director of a Primary Care Network). They explain some of the basics about Primary Care Networks; what they are, their structure, leadership and their purpose. They also cover some aspects of funding including Directed Enhanced Services (DES), discuss how they both became clinical directors and what this role entails, as well as talking about some opportunities to get involved with Primary Care Networks. They finish by explaining what they see to be the pros and cons of Primary Care Networks.  ___ Primary care networks explained, The King's Fund: https://www.kingsfund.org.uk/publications/primary-care-networks-explained?gclid=Cj0KCQjw9_mDBhCGARIsAN3PaFPmi-6hCpND-rBQKNAXuwpng0bFOYVs_BjlShvFWvhfltUoR-PICjAaApQLEALw_wcB Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ If you would like more information about the Additional Roles Reimbursement Scheme (ARRS), then check out some of our other episodes where we interview a representative from each of the new roles that can be employed by Primary Care Networks. ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

By popular demand we are delighted to share this talk about managing peri-menopausal symptoms in general practice! Dr Jacquelyn Gatenby joins us to discuss her approach; starting with common symptoms, alternatives to HRT,  who she feels we should be offering HRT to, and the pros and cons of HRT. We talk about the contraindications, her process for deciding which type of HRT to give, and where testosterone and contraception fit in. ___ Discussion of the history of studies around the safety of hormone replacement therapy: https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-the-history/ The British Menopause Society: https://thebms.org.uk/ The British Menopause Society Breast Cancer Risks factsheet, Nov 2020 (includes the 2019 Collaborative Group for Hormonal Risk Factors and 2020 long term follow-up of the placebo-controlled, randomised Women’s Health Initiative studies): https://thebms.org.uk/wp-content/uploads/2020/11/12-BMS-TfC-Fast-Facts-HRT-and-Breast-Cancer-Risk-01C.pdf My Menopause Doctor, resource by Dr Louise Newson (includes link to download the Balance app): https://www.menopausedoctor.co.uk/ NICE Guidelines: Menopause Diagnosis and Management:  https://www.nice.org.uk/guidance/ng23 FSRH Clinical Guidelines: Contraception for Women Aged over 40 Years (Aug 2017, amended Sept 2019): https://www.fsrh.org/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/ ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Dr Amar Rughani returns to the podcast today to share some great leadership and life skills. We spoke to him in a previous episode about the big picture of leadership skills and why they matter.  In this episode we take a dive into the specifics around getting to know ourselves and how this can be useful both in leadership as well as our everyday lives. We discuss that what drives and inspires us will energise us, and why being our authentic selves can make for better leaders. He talks us through how playing to your strengths is the way forward in leadership, but that we need to know our limits and work with other types of key players to help achieve our goals. ___ Book: Amar Rughani and Joanna Bircher (2020): The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984 Book: Stephen R. Covey: The 7 habits of highly effective people: https://www.goodreads.com/book/show/36072.The_7_Habits_of_Highly_Effective_People Maslow’s Hierarchy of Needs: https://www.simplypsychology.org/maslow.html#gsc.tab=0 William Glasser’s Model of Need: https://wglasser.com/quickstart-guide-to-choice-theory/#basic-needs Primary colours of leadership: edgecumbe.co.uk/the-primary-colours-model/ ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

We are joined by Paediatric Consultant Dr Christos Zipitis to discuss a great overview of infant feeding issues. It was fabulous to go over definitions, presentations and management of colic, gastro oesophageal reflux and reflux disease, lactose intolerance and cow's milk protein allergy. We later touch on the resource ICON designed to help parents cope with crying babies. Thoroughly worthwhile learning for all the general practice team.  ___ The GP Infant Feeding Network (UK): https://gpifn.org.uk/infant-feeding/ Milk Allergy in Primary Care (MAP) Guideline 2019: https://gpifn.org.uk/imap/ GP Online, Feeding Problems in infants (2015): https://www.gponline.com/feeding-problems-infants/paediatrics/paediatrics/article/1377305 Medicines for Children Leaflets: https://www.medicinesforchildren.org.uk NICE guidelines Food allergy in the under 19s: https://www.nice.org.uk/guidance/cg116 NICE Guidelines Gastro-oesophageal Reflux in children and young people, diagnosis and management: https://www.nice.org.uk/guidance/ng1/chapter/introduction Thickeners and bowel obstruction discussion reference: Parmar RS et al. Bezoar and bowel obstruction associated with the use of anti-gatro-oesophageal reflux medication in neonates. Infant. 2015; 11(3): 94-5. https://www.infantjournal.co.uk/pdf/inf_063_str.pdf Discussion on potential side effects of Proton Pump Inhibitors for babies: Cochrane review (2014): Pharmacological treatment of children with gastro‐oesophageal reflux  (see PPI section re possible increased risk of respiratory infections) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2/full?highlightAbstract=inhibitors%7Cside%7Ceffects%7Cinhibitor%7Ceffect%7Cpump%7Cproton Long-term PPI use and association with gastric cancer: Ka Shing Cheung and Wei K Leung. Long-term use of PPIs and risk of gastric cancer: a review of the current evidence. Therapeutic Advances in Gastroenterology. 2019; 12: 1-11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415482/ ICON: Resource for parents about how to cope with crying babies: https://iconcope.org/ ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this episode, we speak to safeguarding nurse lead Sarah Khalil, and adult safeguarding GP lead Dr Rebecca Marchmont about managing self-neglect in adult patients. We discuss the difference between neglect and self neglect, the importance of recognising both, the fundamentals of capacity, where other teams can fit in, and practical tips to help manage these patients. We hope you find the discussion as useful as we did.  ___ Greater Manchester the Self-Neglect Assessment & Management flowchart: https://healthiermanchester.org/wp-content/uploads/2021/03/Self-Neglect-Assessment-and-Management-flow-chart.docx Self Neglect At a Glance Resource by Social Care Institute for Excellence: https://www.scie.org.uk/self-neglect/at-a-glance?gclid=CjwKCAjwu5CDBhB9EiwA0w6sLakH04adirdSw2566BTc4C2Wqv2AXpdTI84zMB117p8dgOJhBjVA9RoCADYQAvD_BwE ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to senior physiotherapists Judith Dawson and Joanne Roberts about how they became involved in physiotherapy in primary care and the roles of physiotherapists in this setting, including First Contact Practitioners. Having been part of enhancing primary care access to physiotherapy throughout the years, it’s great to get their perspectives on the role now and what it might look like in the future. We take the opportunity to get their top tips for managing knee osteoarthritis and low risk back pain.  ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk StartBack tool for low risk back pain: https://startback.hfac.keele.ac.uk/ North of England back pain pathway evaluation: https://www.necsu.nhs.uk/wp-content/uploads/2019/02/2018-05-NorthEnglandRegionalBackPainAndRadicularPainPathway.pdf Knee Osteoarthritis Guidelines (Dec 2020): https://www.guidelines.co.uk/musculoskeletal-and-joints-/nice-osteoarthritis-guideline/247991.article ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

The COVID pandemic caused an upheaval to the endoscopy services for suspected upper and lower gastrointestinal malignancies. To talk us through the changes in how referrals are managed and what that means for us in general practice and our patients, we’re joined by GPwSI in Gastroenterology Dr Sophie Nelson and Consultant Gastroenterologist Dr Alistair Makin. Our discussion includes using FIT tests to risk stratify patients with suspected lower GI malignancies, the use of the Edinburgh Dysphagia Scale for suspected upper GI malignancies, a reminder of 2 week wait criteria, and little on iron deficiency anaemia and Helicobacter Pylori.  ___ Greater Manchester Gastroenterology Webinar 24th Sept 2020. Speakers: Dr Sophie Nelson, Dr Varinda Athwal (LFTs), Dr Sarah Taylor (FIT testing), Dr Alistair Makin (GI cancers), and Dr May Aldean (advice and guidance)  The link includes links to endoscopy pathways. https://gpexcellencegm.org.uk/resources/gm-gastroenterology-gp-education-webinar/#.YEYVCWj7SUk Guidelines for managing patients with dyspepsia in primary care: https://gpexcellencegm.org.uk/resources/guidelines-for-managing-patients-with-dyspepsia-in-primary-care/#.YFEP4C2l23U  NICE Gastrointestinal tract (lower) cancers - recognition and referral (Feb 2021): https://cks.nice.org.uk/topics/gastrointestinal-tract-lower-cancers-recognition-referral/ NICE Gastrointestinal tract (upper) cancers - recognition and referral (Feb 2021): https://cks.nice.org.uk/topics/gastrointestinal-tract-upper-cancers-recognition-referral/ Gateway C (an online cancer education platform for primary care): https://www.gatewayc.org.uk/ Greater Manchester Upper and Lower GI Cancer guidelines are available on TeamNet for Manchester clinicians North West Iron Deficiency Anaemia Guidelines and Coeliac Guidelines: Not yet published but watch out for these soon! ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

The next in our series talking about additional roles in primary care is all about paramedics in general practice. Lisa and Sara speak to Scott Murray, who has been working as a paramedic within primary care for some time now, having transitioned through acute care and urgent care. He talks us through his journey, why he chose to move to primary care and some tips for both paramedics and the general practice team about how to make that transition. ___ Health Education England: Paramedics in Primary Care: (Resource link for paramedics interested in General Practice and for General Practitioners and Practice Managers interested in taking on paramedics): https://www.hee.nhs.uk/our-work/primary-care/first-contact-practitioners-advanced-practitioners-paramedics Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined by Dr Amar Rughani to discuss his approach to leadership. We talk about the importance of considering our influence, place in the world and how to achieve our goals. We consider our motivations for doing what we are doing in life; the importance of taking that step back to really consider why, how and what we are doing in the world and in general practice. From this we can then consider what we want the future to look like. Future episodes will then focus on how to get there. To get in touch with Amar: [email protected] ___ Book: Amar Rughani and Joanna Bircher (2020) The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984 Book: Erich Fromm (2003) Man for Himself First Edition Routledge Classics: https://www.bookdepository.com/Man-for-Himself-Erich-Fromm/9780805014037?ref=grid-view&qid=1612957185376&sr=1-2 Book: Roger Neighbour (2015) The Inner Consultation: How to Develop an Effective and Intuitive Consulting Style, Second Edition, CRC Press: https://blackwells.co.uk/bookshop/product/9781857756791?gC=5a105e8b&gclid=Cj0KCQiApY6BBhCsARIsAOI_GjZXqwnpj-8-NEg_nzo5sFRFej67mV70jhmMP5BQ9Ot-il7VJsyypp8aAuQOEALw_wcB ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

As part of their mini-series in Primary Care New Roles, Lisa and Sara spoke with Physician Associate Ricky Staniland to get an idea of how he became a Physician Associate in General Practice and what his role includes at present. Definite learning points were just how varied and useful Physician associates can be in practice. As part of her role as clinical director of Primary Care Workforce and Greater Manchester Training Hub, Dr Ali Lea joins the discussion. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Health Education England: Physician Associates in Primary Care: (Resource link for Physician Associates interesting in General Practice and for General Practitioners and Practice Managers interested in taking on Physician Associates): https://www.hee.nhs.uk/our-work/primary-care/physician-associates-primary-care North West Physician Associate Training Programmes: https://www.nwpgmd.nhs.uk/physician_associate Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

To teach us more about the New Roles in primary care, as well as the development of existing roles in general practice, Dr Ali Lea and Primary and Community Nurse Lead Lesley Royal-Price join us. The plans for Primary Care Work Transformation are described as ‘making sure we have the right team to deliver the best care looking after people the right way for them’. A great tagline that about sums it up. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Nursing Leadership and Development Programme: https://www.rcn.org.uk/professional-development/professional-services/leadership-programmes Greater Manchester Primary Care Nurse Forum (including quarterly Webinars): https://gmprimarycarecareers.org.uk/gm-primary-care-and-community-nursing-forum-13-10-2020/ Leadership and Development Programme for Practice Nurses and other Primary Care Roles: https://gmprimarycarecareers.org.uk/generalpractice/careers/nursing/care-programme/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Dr Adam Abbs about remote consulting. Dr Abbs is a GP who has written a handbook about remote consulting which has been accredited by the RCGP.  Remote consulting has been in our lives for quite some time now, and this doesn’t look likely to change anytime soon so we thought it was worth getting some more hints and tips to make us all the best remote consulters that we can be. We talk about common pitfalls, how to do some examinations remotely and a couple of special situations such as care homes and patients with visual or hearing impairments. **This is an amended episode from the one originally uploaded this morning as we realised that an older edit had been uploaded in error. Primary Care Pathways Website, Remote Consulting: https://primarycarepathways.co.uk/covid-19/clinical-assessment/resources-to-support-remote-working-for-doctors EGP Learning: https://egplearning.co.uk/ Remote Consultations Handbook: https://www.archealth.io/handbook  GMC Remote Consultations: https://www.gmc-uk.org/ethical-guidance/ethical-hub/remote-consultations  Healthier Together Website: https://what0-18.nhs.uk/professionals/gp-primary-care-staff/clinical-pathways-remote-assessment  ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined by  Dr Uma Marthi (GP with a Special Interest in Gynaecology) to discuss some common gynaecological presentations in young girls up to teenage years. She takes us through her approach to vaginal bleeding in neonates, vaginal itch in toddlers, breast development and vaginal discharge in teenagers.  The British Society for Paediatric and Adolescent Gynaecology (great patient leaflets): https://britspag.org/ Royal College of Obstetrics and Gynaecology guidelines: https://www.rcog.org.uk/en/guidelines-research-services/ NHS Resources example, Vaginal Discharge: https://www.nhs.uk/conditions/vaginal-discharge/ Primary Care Women’s Health Forum: https://pcwhf.co.uk/ eLearning for Health, Female Genital Mutilation Module: https://www.e-lfh.org.uk/programmes/female-genital-mutilation/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Primary Care Knowledge Boost has teamed up with the Greater Manchester GP and GP Nurse Fellowship schemes as well as the Additional roles in General Practice scheme to incorporate episodes related to these topics into our schedule. Here to explain what fellowships are is GP and GM training hub Clinical Lead Dr Gill Tonge. It was really interesting to hear the thinking behind the fellowships and hear the aims of supporting doctors and nurses after the first year of qualifying. The content is free and relevant to all in primary care and will include episodes on remote working, practice management skills, leadership and quality improvement.  Greater Manchester Training Hub (Application for Fellowships): https://www.gmthub.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this episode, Lisa and Sara speak to consultant neurologist, Dr Matt Jones about headaches. The discussion has a focus on the diagnosis and categorisation of common headaches with a touch of management at the end. We talk through where Dr Jones starts when taking a headache history and how he categorises them. We also discuss features that would be concerning to him, as well as thinking about who he would admit on the day. We then go through examination in the light of COVID-19 and helpful tips about headache management. North West Headache Management Guideline (2015): http://gmmmg.nhs.uk/docs/guidance/Headache-guidelines-algorithm-temporary-version-30-04-19.pdf The Migraine Trust: https://www.migrainetrust.org/ Headaches in over 12s: diagnosis and management (Nov 2015): https://www.nice.org.uk/guidance/cg150  National Migraine Centre: Heads Up Podcast all about Migraine: https://www.nationalmigrainecentre.org.uk/migraine-and-headaches/heads-up-podcast/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined by GP and HIV lead for Greater Manchester Dr Marlon Morais and Yvonne Richards, an inspiring positive speaker from George House Trust to talk about HIV in Greater Manchester. We cover what it is, it’s prevalence and opportunities for testing. We then go on to speak about the importance of early diagnosis and effective treatment before hearing from Yvonne about her personal journey with HIV that led her to become a passionate advocate for women living with HIV. The resources are detailed below and we are grateful to Yvonne, Marlon, Victoria Morris and Paul Fairweather for helping to make this episode possible as well as helping to compile these. Latest Government Prevalence Data on HIV in the UK: https://www.gov.uk/guidance/hiv-overall-prevalence NICE HIV testing Guidelines: https://www.nice.org.uk/guidance/ng60/chapter/Recommendations#offering-and-recommending-hiv-testing-in-different-settings British HIV Association (BHIVA) HIV Testing Guidance: https://www.bhiva.org/HIV-testing-guidelines HIV Indicator Diseases, those in which an HIV test is recommended: http://www.eurotest.org/Portals/0/Indicator%20diseases/CHIP_Guidance%20in%20short_UK_updated%20JUN2016_mlj.pdf Manchester HIV Charity George House Trust: https://ght.org.uk/ Liverpool Interaction Checker for HIV Medications: https://www.hiv-druginteractions.org/checker iChart HIV Medication Interaction Checker for Phone: https://play.google.com/store/apps/details?id=com.liverpooluni.icharthiv&hl=en_GB Fingertips Public Health Profiles (can be used to find out the HIV prevalence in UK regions): https://fingertips.phe.org.uk/search/HIV UK Wide Charity Terrence Higgins Trust: https://www.tht.org.uk/ Terrence Higgins Trust on Facebook: https://www.facebook.com/6316017331/posts/10158506443587332/?sfnsn=scwspmo AIDS Maps (HIV and AIDS Charity): https://www.aidsmap.com/ Positively UK HIV Charity: https://positivelyuk.org/ Sophia Forum HIV Charity (focus on politics and women with HIV): https://sophiaforum.net/ National AIDS Trust: https://www.nat.org.uk/ CHIVA: Children’s HIV Association: https://www.chiva.org.uk/ HIV i-Base (HIV Charity focusing on HIV information and advocacy, pictorial approach to HIV): https://i-base.info/ HIV AIDS Foundation: https://www.eltonjohnaidsfoundation.org HIV: Let's sort this together: https://sorthiv.org.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this episode Lisa and Sara talk to Dr Avril Danczak, a GP with an interest in managing uncertainty in medicine which led to her co-authoring the RCGP published book called Mapping Uncertainty in Medicine. We cover what uncertainty is, and why it is important to address this within medicine and general practice. We talk about ‘what to do when you don’t know what to do’, how to classify and identify different forms of uncertainty and then think about how you can go about addressing and managing this uncertainty in a structured way. Useful resources:  Book: Mapping uncertainty in medicine, what to do when you don’t know what to do; Avril Danczak, Alison Lea and Geraldine Murphy (2016): https://www.amazon.co.uk/Mapping-Uncertainty-Medicine-What-When/dp/0850844053 Paper: Varieties of uncertainty in medicine; Paul Han, William Klein and Neeraj Arora (2011): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146626/ Paper: Dealing with uncertainty in general practice: an essential skill for the general practitioner; Margaret O’Riordan et al: https://pubmed.ncbi.nlm.nih.gov/21781433/ Bradford VTS Resources on decisions, diagnoses and uncertainty: https://www.bradfordvts.co.uk/clinical-skills/decisions-diagnoses-uncertainty/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This week’s podcast episode is all about Polycystic Ovarian Syndrome with Tameside Consultant Obstetrician & Gynaecologist Dr Mahshid Nickkho-Amiry. It’s a detailed look at the subject using an example case, following this from diagnosis to management.  Useful resources:  Royal College of Obstetricians and Gynaecologists - Patient Leaflet on Polycystic Ovarian Syndrome (2015): https://www.rcog.org.uk/en/patients/patient-leaflets/polycystic-ovary-syndrome-pcos-what-it-means-for-your-long-term-health/ Verity - Self Help Charity with excellent online resources for patients: https://www.verity-pcos.org.uk/ NICE - Clinical Knowledge Summaries: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/ RCOG - Green Top guidelines - Long terms consequences of PCOS (Nov 2014): https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_33.pdf International evidence-based guideline for the assessment and management of polycystic ovary syndrome (2018): https://pcwhf.co.uk/wp-content/uploads/2018/12/PCOS_Evidence-Based-Guidelines_20181009.pdf Guidelines - Diagnosis and Management of Polycystic Ovarian Syndrome (Jun 2020): https://www.guidelines.co.uk/womens-health/pcos-uk-guideline/236071.article ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Managing the common palliative symptoms of nausea, vomiting and constipation can make a world of difference to the quality of life of our patients. This week, Lisa and Sara are joined again by Drs Liam Hosie and Anna Murray to continue their discussion about managing palliative patients in general practice.  We cover important features in a history that point to the cause of symptoms for nausea/vomiting and constipation. The causes of nausea and vomiting are then broken down to four categories and we consider what medications might work best for these. We go on to discuss managing constipation and point to a helpful guide for further reference. Useful resources:  Greater Manchester Medicines Management Group, Palliative Care Pain and Symptom Control for Adults (Fifth Edition, Nov 2019): http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf#search=%22nausea%22 NICE Clinical Knowledge Summaries, Palliative Care - Nausea and Vomiting: https://cks.nice.org.uk/topics/palliative-care-nausea-vomiting/ NICE Clinical Knowledge Summaries, Palliative Care - Constipation:  https://cks.nice.org.uk/topics/palliative-care-constipation/ Wigan & Leigh Hospice Symptom Management Guidelines for the Care of Adults in the Last Hours or Days of Life (Community Version 3): https://d2abk28tx5gxte.cloudfront.net/app/uploads/2018/11/26165005/symptom_management_guidance_end_of_life_adults_community_v3.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

To help us brush up on managing palliative patients with pain, Lisa and Sara speak to Dr Anna Murray (Palliative Care Specialist, WWL) and GP Lead Dr Liam Hosie (Palliative Care and GP, WWL). We start with a general approach to pain and then move on to consider the causes, discuss opioid titrations as well as adjuvant therapies. We also touch on agitation and breathlessness and when to consider changing the routes of medication. Useful resources:  GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults: http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf Wigan & Leigh Hospice Symptom Management Guidelines for the Care of Adults in the Last Hours or Days of Life (Community Version 3): https://d2abk28tx5gxte.cloudfront.net/app/uploads/2018/11/26165005/symptom_management_guidance_end_of_life_adults_community_v3.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Early diagnosis of cancer is a huge priority in order to try to improve our cancer survival rates in the UK. Lisa and Sara took the opportunity to speak to Dr Sarah Taylor, GP in Fallowfield and Cancer Research UK Cancer Diagnosis Lead for Greater Manchester about this important subject. It was recorded pre-Covid-19 and so some of the information given about services might have changed in your local area. We thought the general tips about picking up cancer as early as possible were incredibly useful however which is why we decided to release the episode.  We cover why early diagnosis of cancer is a priority for the UK, learning points/common themes picked up from significant events in delayed cancer diagnosis, tools that we can use in primary care to help our pick up rate and useful resources for primary care. Useful resources:  Gateway C: https://www.gatewayc.org.uk/ Cancer Research UK Health Professional Section: https://www.cancerresearchuk.org/health-professional Macmillan Health Professional Resources: https://www.macmillan.org.uk/about-us/health-professionals/resources QCancer Score: https://www.qcancer.org/ Cancer Research UK Facilitator Programme: https://www.cancerresearchuk.org/health-professional/learning-and-support/about-our-partnerships/what-is-the-facilitator-programme NICE Suspected cancer - recognition and referral: https://www.nice.org.uk/guidance/ng12 BJGP - Improving early diagnosis of cancer in UK general practice: https://bjgp.org/content/67/659/276 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Good consultation skills can hone diagnosis, management plans, safety-netting and safety thereby really affecting patient outcomes. GP and Primary Care Educator Dr Avril Danczak shares her insights into teaching GP trainees and trainers about consultation skills with Lisa and Sara.  Useful resources:  Health Education North West Advanced Communication Skills Resources https://www.nwpgmd.nhs.uk/resources/advanced-communication-skills-reading-list Article: Kaiser Permanente: Enhancing Clinician Communication Skills in a Large Healthcare Organization: A longitudinal Case Study https://www.sciencedirect.com/science/article/abs/pii/S0738399105000133 Book: Silverman, Kurtz and Draper: Skills for Communicating with Patients https://www.amazon.co.uk/Skills-Communicating-Patients-Jonathan-Silverman/dp/1846193656/ref=pd_rhf_se_p_img_2?_encoding=UTF8&psc=1&refRID=T0WVKH6Y145JAJ1VDHCJ Book: Platt and Gordon: Field Guide to the Difficult Patient Interview https://www.amazon.co.uk/Field-Guide-Difficult-Patient-Interview/dp/0781747740 Book: Barry Bub MD: Communication Skills That Heal https://www.amazon.co.uk/Communication-Skills-That-Heal-Professionalism/dp/1857756649  ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This episode has been made with the support of Health Education North West. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

As part of her role as Associate Dean in Health Education North West, Dr Alison Caldwell looks after GP trainees who sit the AKT and those that may fail. In this episode she shares her pearls of wisdom for preparing and sitting the AKT. It has lots of useful information for trainees and trainers including how to break down the curriculum and where to best focus learning as well as how to actually do that learning effectively. We also cover how to improve exam technique as well as useful resources and specific advice for those who have tried and failed the exam. ____ Useful resources:  Fourteen Fish for GP Trainees: https://www.fourteenfish.com/audience/gptrainee RCGP - MRCGP Applied Knowledge Test (AKT): https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/mrcgp-applied-knowledge-test-akt.aspx RCGP- GP Curriculum Overview: https://www.rcgp.org.uk/training-exams/training/gp-curriculum-overview.aspx BNF Online: https://bnf.nice.org.uk/ RCGP - Clinical evidence and data interpretation: https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/-/media/B4406D5D2E9A492B86AD74BC3FEFD08B.ashx Bolton GP scheme - Medical statistics: http://boltongptraining.org.uk/wp-content/uploads/2013/10/Stats_Handout_2_MEHDI_FARD_ST3.pdf General Practice Education in Health Education England working across the North West: https://www.nwpgmd.nhs.uk/general-practice-education-north-western-deanery  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT  ____ This episode has been made with the support of Health Education North West. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara bring back Dr Joanna Bircher and Dr Viren Mehta for this last episode in the COVID-19 series to reflect on all of the positives that have come from the outbreak in general practice, the personal and professional learning that they have had and some focus on staff wellbeing with a few simple ideas on how to support each other. Thank you to Practice Managers Sara Mayer at Archwood Medical Practice and Michelle Davenport at Heaton Mersey Medical Practice for sharing their insights too. ____ Useful resources:  Headspace - information about free NHS access: https://help.headspace.com/hc/en-us/articles/360044971154-Headspace-for-the-NHS  Looking After You Too coaching: https://people.nhs.uk/lookingafteryoutoo/ NHS Practitioner Health programme: https://www.practitionerhealth.nhs.uk/accessing-the-service RCGP Wellbeing Resources: https://www.rcgp.org.uk/training-exams/practice/gp-wellbeing.aspx  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Now that the Greater Manchester Enabling Safe Certification of Death in the Community service is being stood down, we take the opportunity to talk through the new legislation (from the Coronavirus Act 2020) and how this applies in practice. Dr Aamna Khan (GP and Clinical Lead for the Enabling Safe Certification of Death in the community service) and Dr Viren Mehta (GP partner, clinical director of his PCN and clinical director for Stockport CCG) take us through this important subject. They discuss: Expected and unexpected deaths and how these should be approached Who should be referred to the coroner and when to write COVID-19 on the death certificate Verification of death and who can do this Who can complete paperwork such as the death certificate and cremation forms and the criteria that now needs to be satisfied to enable this to be done Tips on how to complete this paperwork at the moment The ways in which the registration process has changed Thoughts on how practices and PCNs can think about their systems to make death in the community safer and smoother for everyone involved ____ Useful resources:  Information and contact details for Greater Manchester Enabling Safe Certification of Deaths in the Community Service: https://gmprimarycare.org.uk/coronavirus/ Coronavirus Act 2020: http://www.legislation.gov.uk/ukpga/2020/7/contents/enacted Red Whale - COVID-19: Death in the community: https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/28_GP_COVID-19_The-Coronovirus-Act-2020-Death-certification,-cremation-and-burial.pdf  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

At the moment with increased isolation, anxiety and loneliness, social prescribing has become more important than ever. Sara and Lisa speak to GP Dr Jaweeda Idoo (clinical champion for personalised care in Greater Manchester) and Sophie Glinka (social prescribing lead for people and communities in Greater Manchester) about the role of social prescribing during COVID-19 and indeed in general. They talk about some case studies where social prescribing has been invaluable to the care and support of patients, and showcase the importance of this facet of community care.  ____ Useful resources:  The Health Foundation - What makes us healthy? An introduction to the social determinants of health (2018): https://www.health.org.uk/sites/default/files/What-makes-us-healthy-quick-guide.pdf International Journal of Epidemiology - Sick individuals and sick populations (2001): https://academic.oup.com/ije/article/30/3/427/736897 Proceedings of the National Academy of Sciences of the United States of America - Social isolation, loneliness, and all-cause mortality in older men and women (2013): https://www.pnas.org/content/110/15/5797.short  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Staff risk assessments in primary care during COVID-19 are generating many questions such as; Which tool? How should they be carried out? What are the advantages and disadvantages of doing them? How does Vitamin D fit in? What does this mean for practice? GPs Sara and Lisa talk to Greater Manchester based GP Dr Jaweeda Idoo and Practice manager Gina Bird about their experiences of staff risk assessments in general practice at the moment.  ____ Useful resources:  BMJ Covid-19: Known risk factors fail to explain the increased risk of death among people from ethnic minorities May 2020: https://www.bmj.com/content/369/bmj.m1873 NHS Staff Risk Assessments: https://www.nhsemployers.org/covid19/health-safety-and-wellbeing/risk-assessments-for-staff SAAD Risk Assessment: https://abmacademy.com/saad-risk-scoring-for-bame/ Welsh Risk Assessment Tool COVID-19 (WRATC): https://www.bapio.co.uk/wp-content/uploads/2020/05/Risk-Assessment-Tool.pdf RCOG Covid-19 Advice in Pregnancy: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Recorded in January 2020, this is the long awaited second part of Lisa and Sara’s conversation with Professor Anthony Jones and Consultant Physiotherapist William Gregory from Salford Royal Foundation Trust. In Part 1 we covered diagnosis and in Part 2 we look at management of fibromyalgia including: The role of targeted CBT and physiotherapy Groups for patient education and support The role of medications Where secondary care fits in Research in the area The place alternative therapies occupy for some with this condition Natural progression and associated conditions Helpful resources for patients and practitioners ____ Useful resources:  Fibromyalgia Action (FMA) UK website (for patient info and list of local support groups): http://www.fmauk.org/ Versus Arthritis booklet: https://www.versusarthritis.org/about-arthritis/conditions/fibromyalgia/ Pain toolkit: https://www.paintoolkit.org/ Living well with pain: https://livewellwithpain.co.uk/ Moving Medicine: https://movingmedicine.ac.uk/ Theatre Performance for all interested in learning about how the brain works in chronic pain: Pain, the Brain and a little bit of Magic: http://research.bmh.manchester.ac.uk/pain//events/PainTheBrainandabitofMagic Currently available checklist for Fibromyalgia diagnosis on ACR website: https://www.rheumatology.org/Practice-Quality/Clinical-Support/Criteria/ACR-Endorsed-Criteria A version of the 2016 ACR checklist (amended from the 2010 version): https://people.clarkson.edu/~lrussek/2016FMS.pdf  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or make our day and fill out our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

With so much changing in how we work in general practice at the moment, assessing and investigating patients for suspected cancer symptoms can be a challenge. To help talk us through the current situation, Lisa and Sara speak to: Dr Sarah Taylor: GP in Fallowfield and Cancer Research UK Cancer Diagnosis Lead for Greater Manchester Dr Viren Mehta: GP in Cheadle, Clinical Director at Stockport CCG and Clinical Director at his PCN We discuss: Thoughts around how to assess patients with suspected cancer at the moment, including discussion around the remote nature of working currently and the challenges that come with this How to approach ‘cough’ presentations, remembering to continue to consider lung cancer Advice around how to decide who to see face to face The advice around suspected cancer referrals to secondary care at the moment What patients can now expect following a referral to secondary care for suspected cancer ____ Useful resources:  Greater Manchester Cancer Lung Pathway Board - Coronavirus (COVID-19) Resource Centre: https://gmcancer.org.uk/coronavirus/ NICE - Suspected Cancer: Recognition and Referral: https://www.nice.org.uk/guidance/ng12 BMA - Taking and Using Pictures and Recordings of Patients: https://www.bma.org.uk/advice-and-support/ethics/confidentiality-and-health-records/taking-and-using-pictures-and-recordings-of-patients  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Yesterday was international nurses day and so we wanted to highlight the great work that is being done by our community nurses during COVID-19. Our guests are: Lesley Royle-Pryor: Primary and Community Nurse Lead for Greater Manchester Health and Social Care Partnership Moira Ogunsakin: Greater Manchester Training Hub Lead Nurse, Lead Nurse for Practice Renewal for Salford Primary Care Together and Practice Nurse in Salford Dr Joanna Bircher: GP Partner in Tameside and Glossop and Clinical Director of the GP Excellence programme We discuss: What life is like for practice nurses and district nurses at the moment and what has changed since COVID-19 The challenges that community nurses face at the moment How practices can continue to adapt their nursing work going forward Places to look for support as a community nurse Thoughts on how other members of the practice team can support nursing colleagues at the minute and going forward ____ Useful resources:  Asthma UK - How to use your inhaler: https://www.asthma.org.uk/advice/inhaler-videos/ Royal College of Nursing - COVID-19: https://www.rcn.org.uk/covid-19 Nursing and Midwifery Council - COVID-19: https://www.nmc.org.uk/news/coronavirus/ Wound Care at Home: https://www.scribd.com/document/461038756/Wound-Care-at-Home?secret_password=3bSG1Z3zL26wPiiZFRDp  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to doctors involved in primary care research to give an overview of what developments are happening in COVID-19 research in the community at the moment. Our guests are: Professor Philip Evans - GP, Associate Professor of General Practice at The University of Exeter, National Speciality Lead for Primary Care at NIHR, Cluster Lead at Clinical Research Network National Speciality Hub Dr Sheila McCorkindale - GP, Local Clinical Research Speciality Lead at NIHR Clinical Research Network, Greater Manchester  Dr Nick Thomas  - GP, Clinical Research Speciality Lead with NIHR, Clinical Research Lead at the Clinical Innovation and Research Centre at RCGP  We discuss: The ‘PRINCIPLE’ study, the first clinical trial in COVID-19 patients consulting in primary care   The RCGP Research and Surveillance programmes The National Institute for Health Research programmes We reflect on the joined up nature of research efforts between branches and within Primary and Secondary care, contributing to all teams working towards the common goal to help patients nationally at this unprecedented time.  Note: We have taken down episode 4 (managing death in the community) in our COVID-19 series as the Enabling Safe Certification of Death Service has been updated, making parts of the episode no longer relevant. You can check our their FAQ in the resources below for the most up to date information about the service. ____ Useful resources:  Enabling Safe Certification of Death Service FAQ: https://gmprimarycare.org.uk/coronavirus/ The National Institute for Health Research (NIHR) Clinical Research Network (CRN) website: https://www.nihr.ac.uk/explore-nihr/support/clinical-research-network.htm The Urgent Public Health (UPH) studies: https://www.nihr.ac.uk/covid-19/ The ‘PRINCIPLE’ (Platform Randomised trial of INterventions against COVID-19 In older peoPLE) study:  https://www.phctrials.ox.ac.uk/principle-trial NIHR: Be Part of Research: https://bepartofresearch.nihr.ac.uk/ RCGP: Research and Surveillance Centre programmes: https://www.rcgp.org.uk/clinical-and-research/our-programmes/research-and-surveillance-centre.aspx COVID-19 Symptom Tracker App: https://covid.joinzoe.com/​ Moodbuster: https://www.mentalhealth.org.uk/research/moodbuster​ Clinical Practice Research Datalink (CPRD): https://www.cprd.com/  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara take a short break from full recording this week. They give an update on what to hopefully expect from episodes over the next few weeks as well as sharing a couple of useful links and information from listeners. Useful resources:  Bereavement helpline number: 0800 2600 400 Centre for Evidence Based Medicine, Oxford: https://www.cebm.net/ NHS England Time for Care: https://www.england.nhs.uk/gp/gpfv/redesign/gpdp/releasing-time/  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

There have been a lot of questions within primary care regarding shielding and vulnerable patients. Sara and Lisa speak to Dr Joanna Bircher and Dr Viren Mehta about the confusion and get their thoughts on the subject. In the episode we cover: Demystifying all of the terminology and putting it into simpler terms. What has been asked of primary care with regards to these lists of patients, tips on how to complete these tasks and where to look for help. How to support extremely vulnerable/shielded and vulnerable patients as a practice, and how to safely manage clinical issues that arise for these people during COVID-19. Other groups of patients that might need extra support but don’t fall into the shielded (extremely vulnerable, high risk) category. Patient employment issues in primary care with relation to shielding. ____ Useful resources:  Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 (17th April 2020): https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 NHS Guidance and updates for GPs - Highest clinical risk patients: https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/ RCGP - Shielding vulnerable patients from Covid-19 (April 2020): https://elearning.rcgp.org.uk/course/view.php?id=377 NHS Digital - Coronavirus (COVID-19): Shielded patients list: https://digital.nhs.uk/coronavirus/shielded-patient-list NHS Standard operating procedures: https://www.england.nhs.uk/coronavirus/primary-care/general-practice/standard-operating-procedures/ COVID-19: guidance for employees, employers and businesses: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19 Identifying and helping to protect patients most at risk from COVID-19: https://www.rcplondon.ac.uk/news/identifying-and-helping-protect-patients-most-risk-covid-19 BMA - Identifying patients at highest risk from COVID-19: advice for GPs (16th April 2020): https://www.bma.org.uk/news-and-opinion/identifying-patients-at-highest-risk-from-covid-19-advice-for-gps Lymphoma Action - Guidance on shielding for people who have lymphoma: https://lymphoma-action.org.uk/about-lymphoma-covid-19-and-lymphoma/guidance-shielding-people-who-have-lymphoma Myeloma UK - COVID-19: What measures should I be following?: https://www.myeloma.org.uk/news-and-stories/covid-19-information-hub/covid-19-what-measures-should-i-be-following/  Blood Cancer UK - Coronavirus and blood cancer: https://bloodcancer.org.uk/support-for-you/coronavirus-covid-19/coronavirus-blood-cancer/ MPN Voice - COVID-19 Outbreak: Advice for Patients with Myeloproliferative Neoplasms (MPNs) (30th March 2020): https://www.mpnvoice.org.uk/coronavirus-covid-19-advice-and-information/coronavirus_covid_19_advice_for_people_with_mpns.aspx CLL Support - Latest advice on COVID-19 (15th April 2020): https://www.cllsupport.org.uk/latest-advice-on-covid-19/ Clinical guide for the management of Rheumatology patients during the coronavirus pandemic (8th April 2020): https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/clinical-guide-rheumatology-patients-v2-08-april-2020.pdf British Society for Gastroenterology expanded consensus advice for the management of IBD during the COVID-19 pandemic (6th April 2020): https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-of-inflammatory-bowel-diseases-during-the-covid-19-pandemic/ NICE - COVID-19 rapid guideline: severe asthma (3rd April 2020): https://www.nice.org.uk/guidance/ng166 British Thoracic Society - COVID-19: identifying patients for shielding: https://www.brit-thoracic.org.uk/about-us/covid-19-identifying-patients-for-shielding/ Good SAM Volunteer app: Patient referral form: https://www.goodsamapp.org/NHSreferral  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

A current concern for primary care clinicians is how to manage end of life care in the context of the COVID-19 pandemic. Lisa and Sara are joined by Dr Liam Hosie, Dr Adam Firth and Dr Viren Mehta who have sifted through the key information and guidelines that are available on this topic. We talk about: Advanced care planning Common symptoms for patients with COVID-19 at the end of life Discuss 5 guidelines (including NICE, RCGP, Hospice UK) relevant to this topic and some take home messages Anticipatory medication and stock issues Post death support for families and for clinicians ____ Useful resources:  Dr Adam Firth Stockport Grand Round: Making sense of symptom control guidance in suspected COVID - a GPs perspective: https://app.box.com/s/in48s14ee7r1c0pzk2i63m914gr1p0um NG31 NICE Guidelines: Care of dying adults in the last days of life (Dec 2015): https://www.nice.org.uk/guidance/ng31 GMMMG Guidelines: Palliative care pain and symptom control: http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf#search=%22end%20of%20life%22 RCGP: Community palliative, end of life and bereavement care in the COVID-19 pandemic (March 2020): https://elearning.rcgp.org.uk/pluginfile.php/149342/mod_resource/content/1/COVID%20Community%20symptom%20control%20and%20end%20of%20life%20care%20for%20General%20Practice%20FINAL.PDF NICE COVID-19 rapid guideline: Managing symptoms (including at the end of life) in the community (Apr 2020): https://www.nice.org.uk/guidance/ng163 Hospice UK guidance including advice for carers and health care professionals: https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/coronavirus-guidance Harvard Business Review: That Discomfort You’re Feeling Is Grief: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief Funerals and Dying in Absentia: Inspiration and tips during COVID-19: http://www.orderofthegooddeath.com/funerals-dying-in-absentia-inspiration-tips-during-covid-19 RCGP: End of Life Care Quality Improvement Resources: https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/daffodil-standards/end-of-life-care-quality-improvement-resources.aspx  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined by GPs Dr Viren Mehta and Dr Joanna Bircher who summarise new guidelines and evidence relevant in primary care this week. Covered this episode: Clinically recognised natural courses of COVID-19 infection Remotely assessing and risk stratifying COVID-19 patients Learning points from the updated standard operating procedures from NHS England Salient points from the new NICE guidelines on managing pneumonia in adults in the community Briefly touch on the updated PHE guidance on PPE ____ Useful resources:  NICE COVID-19 rapid guideline managing suspected or confirmed pneumonia in adults in the community: https://www.nice.org.uk/guidance/ng165/resources/covid19-rapid-guideline-managing-suspected-or-confirmed-pneumonia-in-adults-in-the-community-pdf-66141902429125 Primary care pathways website: https://primarycarepathways.co.uk/ Centre for evidence based medicine: https://www.cebm.net/covid-19/ PHE what level of PPE, recommended PPE for primary, OP and community care: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.pdf  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this, our second of the COVID-19 specific episodes, GPs Lisa and Sara are joined electronically by Dr Dan Bunstone (GP and Clinical Director of Warrington CCG and Chief Medical Officer at Push Doctor) and Dr Joanna Bircher (GP partner, clinical director for GPExcellence and Pandemic Lead for her PCN). We discuss: Advantages of telephone and video consultations including how to use the golden minute, picking up cues on video consults and when they might be most useful. Safety points around confirming patient identity and others that may be in the room.  The need for excellent documentation for non face to face consultations.  Tips for good safety netting.  Logistics of picking up prescriptions and how to protect shielded groups.  ____ Useful resources  Faculty of Sexual and Reproductive Health Covid-19 specific guidelines:  https://www.fsrh.org/fsrh-and-covid-19-resources-and-information-for-srh/ Trisha Greenhalgh's excellent BMJ article: Covid-19: a remote assessment in primary care:https://www.bmj.com/content/368/bmj.m1182 eGP learning great telephone consultations tips https://egplearning.co.uk/quick-telephone-consultation-tips-for-primary-care/ Red Whale Emotional and Psychological Survival Guide:  https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/PEARL-Emotional-and-Psychological-wellbeing%5B2%5D-EDITED.pdf Website collating useful COVID-19 links: https://primarycarepathways.co.uk/covid19  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

We have decided to take a break from our normal release schedule to do a special, weekly series about the COVID-19 situation which is unfolding. Our hope is that we can provide some useful and practical information for everyone within primary care during this difficult time.  In this first episode we talk to Dr Joanna Bircher (GP partner, clinical director for GPExcellence and Pandemic Lead for her PCN) and Dr Viren Mehta (GP partner, clinical director of his PCN and clinical director for Stockport CCG).  We summarise some of the Standard Operating Procedure from 19th March with practical tips on how to implement this. We think about ways that surgeries can reduce their footfall and protect staff and patients from exposure. We also touch on which normal general practice services should continue during this time and where to look for guidance. We talk about some ways to look after your staff, and speak specifically about home visits. ____ Useful resources:  NHS England Standard Operating Procedure for General Practice (19th March 2020): https://www.england.nhs.uk/coronavirus/primary-care/general-practice/standard-operating-procedures/ RCGP Guidance on workload prioritisation during COVID-19 (23rd March 2020): https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2020/covid19/RCGP%20guidance/202003233RCGPGuidanceprioritisationroutineworkduringCovidFINAL PPE video for UK primary care: https://www.youtube.com/watch?v=Zpg64grevO0 Website collating useful COVID-19 links: https://primarycarepathways.co.uk/covid19  ____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this week’s episode Lisa and Sara speak to Professor Anthony Jones and Consultant Physiotherapist William Gregory from Salford Royal Foundation Trust to learn more about Fibromyalgia. In part 1 we cover what the condition involves, the central sensitisation theory, useful examination tips and differentials to consider. We also talk about simple ways of explaining a diagnosis of Fibromyalgia to your patients.  In part 2 (which will be released in 2 weeks), we break down management options as well as hearing about research and resources helpful to patients and practitioners. ____ Useful resources:  Fibromyalgia prevalence at 1 in 10:  Mansfield et al (2016) A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain 157:1  https://www.ncbi.nlm.nih.gov/pubmed/26270591 American College of Rheumatology (ACR)  2016 fibromyalgia diagnostic criteria: Wolfe F, Clauw DJ, FitzCharles M, Goldenberg D, Hauser W, Katz RS, Russell IJ, Mease PJ, Russell A, Walitt B. 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria. Arthritis Rheumatol. 2016;68 (suppl 10)   https://www.ncbi.nlm.nih.gov/pubmed/27916278 Currently available checklist for Fibromyalgia diagnosis on ACR website:   https://www.rheumatology.org/Practice-Quality/Clinical-Support/Criteria/ACR-Endorsed-Criteria A version of the 2016 ACR checklist (amended from the 2010 version):  https://people.clarkson.edu/~lrussek/2016FMS.pdf National Rheumatoid Arthritis Society - Have you got the S factor?: https://www.nras.org.uk/have-you-got-the-s-factor- FMA UK website (for patient info and list of local support groups): http://www.fmauk.org/ Changes in healthcare utilisation pre- versus post- diagnosis; Hughes et al (2006) The impact of a diagnosis of fibromyalgia on healthcare resource use by primary care patients in the UK. Arthritis and Rheumatism (54, 1, p177-183) https://www.ncbi.nlm.nih.gov/pubmed/16385513  ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Interstitial lung disease (ILD) can be difficult to identify in primary care and unfortunately for some patients, currently carries a poor prognosis; the median survival for those with idiopathic pulmonary fibrosis is only 3–3.5 years (https://www.england.nhs.uk/wp-content/uploads/2018/08/Interstitial-lung-disease-service-adult.pdf). Lisa and Sara talk to respiratory consultant Dr Ashish about this condition. We learn about when to be suspicious about a diagnosis of ILD, who is at risk and the symptoms and signs. We also hear about the reliability of the different investigations that are recommended in primary care and what happens after we have referred someone to outpatient respiratory clinic. We end with talking through how to manage exacerbations in these patients, prognosis and a little bit about fitness to fly. ____ Useful resources:  IPF Lung Sounds: https://www.insightsinipf.com/clinical-resources/auscultation/gallery/ GMMMG Shared Care Guidelines: http://gmmmg.nhs.uk/html/gmmmg_app_scgs.php Fitness to Fly article from British Thoracic Society Standards of Care Committee: 'Managing passengers with respiratory disease planning air travel': https://thorax.bmj.com/content/57/4/289  ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Worldwide, sepsis kills more people than cancer (https://www.bbc.co.uk/news/health-51138859). In 2050 it is predicted antibiotic resistance will kill more than cancer (http://bsac.org.uk/securing-new-drugs-for-future-generations/). What a difficult balance! Lisa and Sara opportunistically talk to Trafford GP Dr Anya Leaver about antibiotic prescribing in Greater Manchester. We discuss the issues, recent changes in local guidelines, helpful tips to improve prescribing practice, great resources and ideas for practice audits.  ____ Useful resources:  Trafford’s two page CCG Antibiotic guidelines. Not online but may be available on request from: [email protected] Other Greater Manchester CCG Medicine Management Teams available from link: http://psnc.org.uk/greater-manchester-lpc/service-information/medicines-management-and-guidance/ GMMMG Antimicrobial Guidelines: http://gmmmg.nhs.uk/html/cgp.php TARGET leaflets for patients from RCGP (including 'Treating your infection UTI'): https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/amr/target-antibiotics-toolkit.aspx 'When should I worry?' leaflets and online resources including e-learning: http://www.whenshouldiworry.com/ Fever Pain score for sore throats: https://ctu1.phc.ox.ac.uk/feverpain/index.php Why the guidelines were changed for treating Chlamydia: https://www.bashhguidelines.org/current-guidelines/urethritis-and-cervicitis/chlamydia-2015/ ESPAUR report (national data on antibiotic prescribing and resistance): https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report  ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to several different primary care professionals about portfolio working. Dr Anya Leaver, Dr Hussain Gandhi, Practice Nurse Alyson Rimmer, Dr Nikesh Vallabh, and Dr Saira Zaman share with us their journey into Primary Care, how they got involved in their different roles outside of clinical work, what it means to them and advice for those out there wanting to explore adding variety to their working week.   ____ Useful resources:  eGP Learning (made by Dr Gandhi): https://egplearning.co.uk/ PED Course with Health Education North West: https://www.nwpgmd.nhs.uk/ped-2019-study-day-one Post-CCT Fellowships with Health Education North West: https://www.nwpgmd.nhs.uk/post-cct-gp-fellowship-programme-hee-nw-20192020  ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GPwSI, Dr Rachel Hilton about Urticaria (aka hives/wheals).  She talks us through the pathophysiology, causes, potential triggers, history, examination and management of this sometimes difficult area. ____ Useful resources:  Skin Support Website (urticaria page): http://skinsupport.org.uk/conditions-details/urticaria-and-angioedema British Association of Dermatologists (urticaria leaflet): http://www.bad.org.uk/for-the-public/patient-information-leaflets/urticaria-and-angioedema NICE CKS urticaria: https://cks.nice.org.uk/urticaria#!diagnosis  ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GPwSI, Dr Rachel Hilton about Generalised Itching. She talks us through how to approach a patient presenting with generalised itching, the common and important causes, useful investigations and the management that we can try in primary care for these patients.  ____ Useful resources:  BATHE Study, BMJ 2018: https://www.bmj.com/content/361/bmj.k1332 Skin Support Website (pruritus page): http://skinsupport.org.uk/conditions-details/pruritus British Association of Dermatologists (pruritus leaflet): http://www.bad.org.uk/for-the-public/patient-information-leaflets/pruritus NICE CKS Widespread Itching Causes: https://cks.nice.org.uk/itch-widespread#!backgroundSub:1  ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Dr Rebecca Baron from Health Education England about Resilience. This is part two of a two-part series about Resilience. In this episode we continue the theme of exploring resources available to healthcare professionals around resilience; books and research that have advanced the field. Rebecca gives us her learning points from these. ____ Resources mentioned in the episode: • When “resilience” becomes a dirty word - BMJ article by David Oliver July 2017 https://www.bmj.com/content/358/bmj.j3604 • 'eGPLearning PodBlast' podcast - episode about Wellbeing with Dr Helen Garr: https://www.podbean.com/eu/pb-w2jut-c480f4 • 'You are not a frog' podcast by Dr Rachel Morris all about Resilience: https://shapesfordoctors.com/podcasts/ • NHS Practitioner Health Programme https://php.nhs.uk/ or call 020 3049 4505 • Positivity book by Barbara Fredrickson https://amzn.to/2OFrOcw • Rainy Brain, Sunny Brain book by Elaine Fox https://amzn.to/2DfE6D2 • Building Physician Resilience Canadian Family Physician May 2008 https://www.nwpgmd.nhs.uk/resources/building-physician-resilience • Foundation for Positive Mental Health http://www.foundationforpositivementalhealth.com/ • Thinking, Fast and Slow book by Daniel Kahneman https://amzn.to/2XO3Pfo • The New Leaders book by Daniel Goleman https://amzn.to/2KP8Miy • The 7 Habits of Highly Effective People book by Stephen R. Covey https://amzn.to/34jcOHM • Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6 • Why We Sleep book by Matthew Walker https://amzn.to/35ugNkW • The Business of Sleep book by Vicki Culpin https://amzn.to/37AINoV • The Body Keeps a Score book by Bessel van der Kolk https://amzn.to/2XIuVEw • Eat that Frog book by Brian Tracy https://amzn.to/33jNaBc ____ We would love your feedback & suggestions…Let us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Dr Rebecca Baron from Health Education England about Resilience. This is part one of a two part series about Resilience. In this episode we talk about what Resilience is and how it started as a concept in general and in healthcare. We also hear about the neuroscience behind Resilience and Rebecca goes through some resources that she has found particularly helpful herself. ____ Resources mentioned in the episode:  BMJ article by David Oliver - When “resilience” becomes a dirty word:  https://www.bmj.com/content/358/bmj.j3604 'eGPLearning PodBlast' podcast - episode about Wellbeing with Dr Helen Garr:  https://www.podbean.com/eu/pb-w2jut-c480f4 'You are not a frog' podcast by Dr Rachel Morris all about Resilience:  https://shapesfordoctors.com/podcasts/ NHS Practitioner Health Programme https://php.nhs.uk/ or call 020 3049 4505 The Body Keeps the Score book by Bessel van der Kolk: https://amzn.to/34wKpxp  The Chimp Paradox book by Professor Steve Peters: https://amzn.to/2JKIlKm  Blink: The Power of Thinking Without Thinking book by Malcolm Gladwell: https://amzn.to/2C7Dizl  Flourish book by Martin Seligman: https://amzn.to/2NGJvrH  Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6  ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Haematologist Dr Chris Gregory about Immunoglobulins. The subject is approached from the point of view of primary care clinicians ordering immunoglobulin blood tests. We get Dr Gregory's opinion on when it is useful to order an immunoglobulins blood test and go through the possible meaning of all the different types of results. We discuss raised immunoglobulin tests and the difference between monoclonal and polyclonal rises. We discuss the diagnosis of MGUS (monoclonal gammopathy of undetermined significance) and myeloma.   ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Haematologist Dr Chris Gregory about B12 and folate deficiency. In this episode we talk about B12 and folate deficiency; How to investigate further and manage these results as well as touching on other causes of macrocytosis including haemolytic anaemia.  ____ Useful resources:  British Society for Haematology guidelines 'Diagnosis of B12 and Folate Deficiency': click here (https://b-s-h.org.uk/guidelines/guidelines/diagnosis-of-b12-and-folate-deficiency/)  ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Haematologist Dr Chris Gregory about anaemia and iron deficiency. In this episode we talk generally about anaemia, how to interpret full blood count results and iron deficiency anaemia. ____ Useful resources:  Blood Journal article 'So you know how to treat iron deficiency anemia': click here http://www.bloodjournal.org/content/126/17/1971?sso-checked=true  ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GP Dr Gatenby about contraception. In this episode we talk about when contraception becomes effective when starting or swapping contraception types, quick starting pills, post-natal/breast feeding considerations for contraception as well as contraception around peri-menopause.  ____ Useful resources:  FSRH up to date guidance for all contraception matters: click here Stockley's interactions checker (requires subscription): click here  ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GP Dr Gatenby about contraception. In this episode we talk about why contraception is so important, types of contraception, the new ways to take the COCP, the differences between preparations of pills, different bleeding patterns on hormonal contraception and options to manage these.  ____ Useful resources:  FSRH up to date guidance for all contraception matters: click here  ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Cardiologist Dr Karthikeyan about palpitations and atrial fibrillation.  ____ Resources mentioned in the episode: BMJ best practice article about pheochromocytoma: click here (requires login) NICE CKS, anti-coagulation: click here NICE CKS atrial fibrillation: click here  ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here  ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Cardiologist Dr Karthikeyan about cardiac causes for blackouts.  ____ Resources mentioned in the episode: - GMC guidance on reporting driving concerns: click here - DVLA fitness to drive guidance: click here   ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here   ____   This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Cardiologist Dr Arya about Heart failure. Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ------------------------- This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Gastroenterologist Dr Bliss about Irritable Bowel Syndrome.  ***THIS EPISODE HAS BEEN RE-UPLOADED WITH ADDITIONAL INFORMATION ABOUT CA125 BLOOD TESTS*** Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ------------------------- This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Gastroenterologist Dr Bliss about abnormal liver function tests.  Here is a link to the NAFLD score calculator Have feedback or suggestions? You can get in touch by either emailing us directly at [email protected] or on Twitter @PCKBpodcast You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ------------------------- This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Gastroenterologist Dr Bliss about acid reflux.  Have feedback or suggestions? You can get in touch by either emailing us directly at [email protected] or on Twitter @PCKBpodcast You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ------------------------- This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara introduce themselves and the plan for the coming podcasts.    Twitter contact: PCKBpodcast Email contact: [email protected]