Primary Care Knowledge Boost

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
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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
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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 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.
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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/
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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 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.
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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
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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
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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
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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 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. 
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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 tipshttps://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.
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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.
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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
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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.

Bronchiectasis can sometimes be overlooked amongst the other, more common lung conditions such as COPD. Because of this, it can be difficult for primary care clinicians to be fully aware of how to comprehensively diagnose and manage patients who have this condition. 
Lisa and Sara talk to respiratory consultant Dr Ashish about bronchiectasis. We learn exactly what this condition is, what the risk factors are for developing it, and when we should be suspicious of it as a cause. We also talk through important differentials to think about, what to look for on examination and which investigations to do (and the reliability of these). We finish by hearing about the role of sputum samples and what we can be doing in Primary Care to manage patients with bronchiectasis alongside Secondary Care.
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Useful resources: 
Table showing targeted antibiotic choices in bronchiectasis on NICE CKS: https://cks.nice.org.uk/bronchiectasis#!scenario:1 
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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
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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.