Primary Care Knowledge Boost

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

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

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

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

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

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

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

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

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

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