Primary Care Knowledge Boost

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

By popular demand we are delighted to share this talk about managing peri-menopausal symptoms in general practice! Dr Jacquelyn Gatenby joins us to discuss her approach; starting with common symptoms, alternatives to HRT,  who she feels we should be offering HRT to, and the pros and cons of HRT. We talk about the contraindications, her process for deciding which type of HRT to give, and where testosterone and contraception fit in.
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Discussion of the history of studies around the safety of hormone replacement therapy: https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-the-history/
The British Menopause Society: https://thebms.org.uk/
The British Menopause Society Breast Cancer Risks factsheet, Nov 2020 (includes the 2019 Collaborative Group for Hormonal Risk Factors and 2020 long term follow-up of the placebo-controlled, randomised Women’s Health Initiative studies): https://thebms.org.uk/wp-content/uploads/2020/11/12-BMS-TfC-Fast-Facts-HRT-and-Breast-Cancer-Risk-01C.pdf
My Menopause Doctor, resource by Dr Louise Newson (includes link to download the Balance app): https://www.menopausedoctor.co.uk/
NICE Guidelines: Menopause Diagnosis and Management:  https://www.nice.org.uk/guidance/ng23
FSRH Clinical Guidelines: Contraception for Women Aged over 40 Years (Aug 2017, amended Sept 2019): https://www.fsrh.org/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/
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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.

Dr Amar Rughani returns to the podcast today to share some great leadership and life skills. We spoke to him in a previous episode about the big picture of leadership skills and why they matter. 
In this episode we take a dive into the specifics around getting to know ourselves and how this can be useful both in leadership as well as our everyday lives. We discuss that what drives and inspires us will energise us, and why being our authentic selves can make for better leaders. He talks us through how playing to your strengths is the way forward in leadership, but that we need to know our limits and work with other types of key players to help achieve our goals.
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Book: Amar Rughani and Joanna Bircher (2020): The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984
Book: Stephen R. Covey: The 7 habits of highly effective people: https://www.goodreads.com/book/show/36072.The_7_Habits_of_Highly_Effective_People
Maslow’s Hierarchy of Needs: https://www.simplypsychology.org/maslow.html#gsc.tab=0
William Glasser’s Model of Need: https://wglasser.com/quickstart-guide-to-choice-theory/#basic-needs
Primary colours of leadership: edgecumbe.co.uk/the-primary-colours-model/
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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.

We are joined by Paediatric Consultant Dr Christos Zipitis to discuss a great overview of infant feeding issues. It was fabulous to go over definitions, presentations and management of colic, gastro oesophageal reflux and reflux disease, lactose intolerance and cow's milk protein allergy. We later touch on the resource ICON designed to help parents cope with crying babies. Thoroughly worthwhile learning for all the general practice team. 
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The GP Infant Feeding Network (UK): https://gpifn.org.uk/infant-feeding/
Milk Allergy in Primary Care (MAP) Guideline 2019: https://gpifn.org.uk/imap/
GP Online, Feeding Problems in infants (2015): https://www.gponline.com/feeding-problems-infants/paediatrics/paediatrics/article/1377305
Medicines for Children Leaflets: https://www.medicinesforchildren.org.uk
NICE guidelines Food allergy in the under 19s: https://www.nice.org.uk/guidance/cg116
NICE Guidelines Gastro-oesophageal Reflux in children and young people, diagnosis and management: https://www.nice.org.uk/guidance/ng1/chapter/introduction
Thickeners and bowel obstruction discussion reference: Parmar RS et al. Bezoar and bowel obstruction associated with the use of anti-gatro-oesophageal reflux medication in neonates. Infant. 2015; 11(3): 94-5. https://www.infantjournal.co.uk/pdf/inf_063_str.pdf
Discussion on potential side effects of Proton Pump Inhibitors for babies:Cochrane review (2014): Pharmacological treatment of children with gastro‐oesophageal reflux  (see PPI section re possible increased risk of respiratory infections)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2/full?highlightAbstract=inhibitors%7Cside%7Ceffects%7Cinhibitor%7Ceffect%7Cpump%7Cproton
Long-term PPI use and association with gastric cancer: Ka Shing Cheung and Wei K Leung. Long-term use of PPIs and risk of gastric cancer: a review of the current evidence. Therapeutic Advances in Gastroenterology. 2019; 12: 1-11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415482/
ICON: Resource for parents about how to cope with crying babies: https://iconcope.org/
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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.

In this episode, we speak to safeguarding nurse lead Sarah Khalil, and adult safeguarding GP lead Dr Rebecca Marchmont about managing self-neglect in adult patients. We discuss the difference between neglect and self neglect, the importance of recognising both, the fundamentals of capacity, where other teams can fit in, and practical tips to help manage these patients. We hope you find the discussion as useful as we did. 
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Greater Manchester the Self-Neglect Assessment & Management flowchart: https://healthiermanchester.org/wp-content/uploads/2021/03/Self-Neglect-Assessment-and-Management-flow-chart.docx
Self Neglect At a Glance Resource by Social Care Institute for Excellence: https://www.scie.org.uk/self-neglect/at-a-glance?gclid=CjwKCAjwu5CDBhB9EiwA0w6sLakH04adirdSw2566BTc4C2Wqv2AXpdTI84zMB117p8dgOJhBjVA9RoCADYQAvD_BwE
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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 senior physiotherapists Judith Dawson and Joanne Roberts about how they became involved in physiotherapy in primary care and the roles of physiotherapists in this setting, including First Contact Practitioners. Having been part of enhancing primary care access to physiotherapy throughout the years, it’s great to get their perspectives on the role now and what it might look like in the future. We take the opportunity to get their top tips for managing knee osteoarthritis and low risk back pain. 
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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
StartBack tool for low risk back pain: https://startback.hfac.keele.ac.uk/
North of England back pain pathway evaluation: https://www.necsu.nhs.uk/wp-content/uploads/2019/02/2018-05-NorthEnglandRegionalBackPainAndRadicularPainPathway.pdf
Knee Osteoarthritis Guidelines (Dec 2020): https://www.guidelines.co.uk/musculoskeletal-and-joints-/nice-osteoarthritis-guideline/247991.article
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This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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

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

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

As part of their mini-series in Primary Care New Roles, Lisa and Sara spoke with Physician Associate Ricky Staniland to get an idea of how he became a Physician Associate in General Practice and what his role includes at present. Definite learning points were just how varied and useful Physician associates can be in practice. As part of her role as clinical director of Primary Care Workforce and Greater Manchester Training Hub, Dr Ali Lea joins the discussion.
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Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/
Health Education England: Physician Associates in Primary Care: (Resource link for Physician Associates interesting in General Practice and for General Practitioners and Practice Managers interested in taking on Physician Associates): https://www.hee.nhs.uk/our-work/primary-care/physician-associates-primary-care
North West Physician Associate Training Programmes: https://www.nwpgmd.nhs.uk/physician_associate
Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/
Greater Manchester Training Hub: https://www.gmthub.co.uk
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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.