Primary Care Knowledge Boost

Doctors Lisa and Sara talk to Locum Consultant Dr Caitriona MacDermott about assessing and managing constipation in Palliative Patients. A common symptom with a significant impact on people’s quality of life, the episode aims to get across the importance of the topic, the often multifactorial nature of clinical scenarios, the red flags not to miss and arm you with a logical and holistic approach to management. We discuss how management might differ for patients with certain conditions such as partial bowel obstruction, neurological causes, or liver disease. An important listen for those of us in the community looking after palliative patients. 
 
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
Clinical Knowledge Summaries from NICE: Palliative Care - Constipation (Updated Feb 2024): https://cks.nice.org.uk/topics/palliative-care-constipation/
NICE CKS Table of Doses of Laxatives that can be used for Palliative Patients: https://cks.nice.org.uk/topics/palliative-care-constipation/prescribing-information/doses-of-laxatives/
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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.

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]
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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
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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]
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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.