Primary Care Knowledge Boost

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.
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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
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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.

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. 
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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
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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.

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.  
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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
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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.

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.
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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
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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.

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. 
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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
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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.

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 2017https://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 Programmehttps://php.nhs.uk/ or call 020 3049 4505
• Positivity book by Barbara Fredricksonhttps://amzn.to/2OFrOcw
• Rainy Brain, Sunny Brain book by Elaine Foxhttps://amzn.to/2DfE6D2
• Building Physician Resilience Canadian Family Physician May 2008https://www.nwpgmd.nhs.uk/resources/building-physician-resilience
• Foundation for Positive Mental Healthhttp://www.foundationforpositivementalhealth.com/
• Thinking, Fast and Slow book by Daniel Kahnemanhttps://amzn.to/2XO3Pfo
• The New Leaders book by Daniel Golemanhttps://amzn.to/2KP8Miy
• The 7 Habits of Highly Effective People book by Stephen R. Coveyhttps://amzn.to/34jcOHM
• Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6
• Why We Sleep book by Matthew Walkerhttps://amzn.to/35ugNkW
• The Business of Sleep book by Vicki Culpinhttps://amzn.to/37AINoV
• The Body Keeps a Score book by Bessel van der Kolkhttps://amzn.to/2XIuVEw
• Eat that Frog book by Brian Tracyhttps://amzn.to/33jNaBc
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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.
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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 Programmehttps://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
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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. 
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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. 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. 
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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.
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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.