MIMS Learning blog

How will the 10-year plan affect GPs’ everyday clinical practice?

4 August 2025

Dawn Liz Powell, medical editor

The Government’s new 10-year plan for the NHS — Fit for the future — was launched with great fanfare last month, and the plan makes several bold claims about how the Government intends to reform the NHS. And reform, according to the plan, is desperately needed (‘reform or die’ in fact) because the NHS is at ‘breaking point’. ‘We can continue down our current path, making tweaks to an increasingly unsustainable model, or we can take a new course and reimagine the NHS through transformational change that will guarantee its sustainability for generations to come,’ the plan states and declares that the Government is choosing the latter.

The goals set out in the plan include creating a ‘neighbourhood health service’, embracing AI to ‘move from analogue to digital’ to put ‘power in your hands’ (‘your’ referring to Josephine Public), and a ‘moonshot’ aim to end the obesity epidemic.

A key question for healthcare professionals who work in primary care is, what does this all mean for them?

The proposed transfer of care from hospital to the community sounds like a good idea, offering a more patient-centred, local service. The stated aim of reducing health inequalities also seems promising (though the plan was launched one week after the Government revised its proposed reforms to disability benefits because of backlash that they were unfair). Addressing health inequalities is a topic close to MIMS Learning’s heart, given last year we ran an award-winning campaign on the issue.

However our sister publication, GPonline, reports that GPs are uncertain about the way neighbourhood health will be delivered. Editor Emma Bower reports that the British Medical Association believes that the plan could unlock additional funding for general practice, or lead the profession towards becoming a salaried service, while deputy editor Nick Bostock writes that some GPs think that the plan is ‘risky as hell’ for general practice, and Dr Tom Riddington comments that embracing AI will not solve the NHS’s workforce problems.

The obesity moonshot is another welcome direction of proposed travel. But there is a long way to go to turn back the trends of rising childhood obesity and meet the demand for newer weight loss therapy among people living with obesity (which, in fairness, is probably why the plan uses the word ‘moonshot’). MIMS Learning plans to keep on top of this important issue, and recently updated its module on obesity in adults.

Another sister publication, MIMS, has looked at what the plan may mean for prescribing. Editor Chloe Harman and I (we are so closely related to MIMS, we share staff) outline proposals for a single national formulary. Due to be created within the next two years, this formulary will replace local formularies.

The plan claims that the aim of the formulary is to put an end to ‘postcode lottery prescribing’ and reduce bureaucracy but, rather predictably, the aim seems to be more about reducing costs. For instance, to support the formulary, an oversight board will be created and will be responsible for ranking medications included in the formulary, based on clinical and cost-effectiveness (supported by NICE).

Other measures that may affect clinical practice include broadening NICE’s remit to re-evaluate and retire previously approved interventions on a rolling basis if it determines that they are no longer cost-effective, speeding access to new medicines through closer collaboration between NICE and the MHRA, and negotiating new partnerships with industry to test innovative models of delivery​ and to provide access on a ‘pay for impact on health outcomes’ basis​.​

The reality, of course, is that only time will tell if the plan revolutionises the NHS (for better or for worse) or if GPs find that they continue to battle the same old issues…

Whatever happens, though, our plan at MIMS Learning is to continue to bring you thought-provoking clinical education to meet your educational needs. We publish new CPD modules every Monday and new episodes of our Clinical Update podcast every Wednesday. You can keep up to speed with our content by subscribing to our biweekly update bulletins.

GP practices are encountering a wave of demand for newer weight loss therapy

17 July 2025

Pat Anderson, editor

Understanding about the nature of obesity is changing, with increasing recognition that it is a complex medical condition rather than a ‘lifestyle choice’, GP Dr Toni Hazell says in the latest episode of our Clinical Update podcast.

‘There's complex interactions of the different hormones that govern hunger and satiety, which make it extremely difficult to lose weight if you have been affected by obesity for some long period of time.’

She says that patients’ stories about the obesity stigma they've faced from healthcare professionals have been ‘really heartbreaking’.

In the last few years, the availability of newer weight loss therapies (GLP-1 agonists and GIP/GLP-1 dual agonists) has brought obesity into the spotlight.

Spurred on by news headlines in June about the weight loss therapy tirzepatide being available for obesity management from NHS GP practices, patients have been inundating GP practices with requests for this ‘game-changing’ weight loss drug, Dr Hazell says.

At the moment, though, the drug is not available from NHS GPs. Patients will have to wait until practices have signed up to local enhanced services (LESs) to deliver tirzepatide – or access a community weight loss service, and, even then, they will have to meet strict criteria in order to qualify.

In the meantime, it’s well-known that many people have been accessing tirzepatide privately, with GP practices encountering requests from private providers to advise on contraindications, or having to deal with side-effects from its use.

So primary care is already faced with a wave of new demands associated with the obesity revolution – and one aspect that GPs need to be aware of is a potential impact on people who are also taking oral contraceptives or HRT. The concern is that the gastrointestinal effects of GLP-1 agonists and GIP/GLP-1 dual agonists will affect absorption of hormones taken orally.

Women taking GLP-1 medications are advised to use effective contraception, specifically non-oral methods around the time of initiation of tirzepatide or dose increases. Dr Hazell says that losing weight in itself may also make conception more likely.

Where HRT regimens are concerned, the issue is around reduced absorption of oral progestogens and the associated reduction in endometrial protection (many women combine transdermal oestrogen with oral micronised progestogen, and, ‘it's the unbalancing of the two, which is a problem,’ says Dr Hazell). She has been involved in creating Primary Care Women’s Health Society guidance, which takes a pragmatic approach to increasing progestogen doses for those women who do not use a levonorgestrel intrauterine device as the progestogen component of their HRT.

Listening to this podcast and reviewing the updated information in our Obesity in adults module will help you keep your head above water.

MIMS Learning scoops prestigious award for Targeting Health Inequalities campaign

26 June 2025

Rhiannon Ashman, deputy editor

Last night was an unusually late one for me because I was at the Professional Publisher’s Association (PPA) awards – a prestigious media awards ceremony, in London. To my shock and delight, MIMS Learning won the award for ‘Campaign for Good’ for our work on Targeting Health Inequalities.

My shock is not because I think we’re undeserving of the award (more below on why we really are!) but because we were up against stiff competition. We're a small editorial team on MIMS Learning, so it is a great feeling to be recognised among some much bigger and better-known names.

The judges said this was ‘an impressive campaign with real substance, integrity, intelligence, and deep respect for its audience.’

This deep respect for our audience – all of you working at the forefront of primary care – is what spurs us on.

Recognising the profound health disparities faced by certain socioeconomic groups, women, ethnic groups, and the LGBTQIA+ community, we launched this campaign back in early 2024 to educate and inspire you.

We understand that you are clear on the existence of inequalities, but may feel overwhelmed by the scale of the challenge. So, the 20 learning modules, podcasts and webinars that make up the campaign focused on ‘what can be done?’, giving you practical steps for change. It was important that these learning modules, written with expert authors, were not just educational, but also designed to inspire action and foster a sense of agency for busy primary care professionals.

The campaign addressed often-overlooked topics, such as healthcare for displaced people, and hidden communities, such as those living in prison or who are homeless. We also focused on the NHS’ ‘target populations’, such as those with psychiatric, or chronic lung conditions.

Our commitment was to create a positive impact, and I hope you’ll take a look at the modules, or listen to a podcast – you may just come away feeling inspired and re-energised to do what you can to contribute to a more equal society.

Urologists suggest updates in DRE for suspected prostate cancer

12 June 2025

Prostate Cancer UK

Prostate cancer is now England’s most common cancer – and the only common cancer without a screening programme.

During Men’s Health Week, the British Association of Urological Surgeons (BAUS) announced that it will work with NHS England and other stakeholders in advising GPs that men with suspected prostate cancer do not need a digital rectal exam (DRE) before being referred for further investigations.

This advice follows a landmark clinical consensus last year – which is reflected in the NHS’s Getting it Right First Time (GIRFT) prostate cancer guidelines.

Despite this, survey data show DRE is still being offered to men. Of 750 men who asked their GP for a PSA blood test, a third were offered a rectal exam as well. Alarmingly, 3% of these men were offered a rectal exam instead of a PSA test.

Evidence-based diagnostic pathways

Although the DRE was historically considered a standard test, the information a GP can get from a rectal exam is of extremely limited value. Thankfully, since the introduction of MRI and modern targeted biopsies as standard in the NHS in 2019, the diagnostic process is more accurate than ever. It’s also never been safer. Research shows that the way prostate cancer is now diagnosed — with a PSA test followed by an MRI scan — reduces potential harms to men by 79%.

Patient barriers

Evidence shows that fear of rectal exams is the greatest barrier to men talking to their GP about the PSA blood test. Research from Prostate Cancer UK found that of more than 2,000 men asked, 60% were concerned about having a rectal exam. Of those, 37% would not speak to a GP about prostate worries because they feared a DRE.

Black men — who have twice the risk of getting prostate cancer and dying from it than white men — report an even greater stigma about rectal exams.

Key messages

Vishwanath Hanchanale, chair of Section of Oncology at BAUS said: ’Digital rectal examination has long been a part of how we assess prostate health, but the truth is, with modern tools like PSA blood tests and MRI scans offering far more accurate insight, the DRE is increasingly redundant in prostate cancer diagnosis. In practice, many men referred with abnormal DREs are found to have normal results when assessed by urology specialists.’

‘Our message to GPs is: if a man has a raised PSA result there is no need to do a physical exam – refer him for an MRI which will far more accurately identify whether or not he has cancer.’

Prostate Cancer UK supports health professionals to improve the early diagnosis of prostate cancer. To find out more and access free resources and latest updates, click here.

Prostate Cancer UK is partnering with MIMS Learning on our Patient, Presentation, Pathway for Cancer campaign. Access the campaign resources here.

Further reading

National Prostate Cancer Audit. NPCA Short Report 2021. 2021.

National Prostate Cancer Audit. NPCA Short Report 2022. 2022.

Prostate Cancer UK. PSA Consensus 2024. 2024.

UK Government. Advising well men about the PSA test for prostate cancer: Information for GPs. 12 December 2024.

Patient information

NHS. PSA test. 2 September 2024

Can ‘Sonic Hedgehog’ encourage sun protection this summer?

15 May 2025

Rhiannon Ashman, deputy editor

Recent sunny days prompted me to revisit MIMS Learning’s excellent skin cancer modules, and two points struck me.

First – despite public awareness campaigns, and valiant patient education efforts by healthcare professionals – risky UV exposure persists.

The authors of learning modules on basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) explain that, ‘as our ageing population expands, and sun-seeking behaviour continues’ the incidence of these cancers continues to rise (the incidence of BCC is ‘almost as high as that of all other cancers combined’).

Consultant dermatologist Dr Suchitra Chinthapalli, has previously discussed a study on tanning beds which found prevalence of indoor tanning had decreased to approximately 5% but, concerningly, there was lower risk awareness among current users and more likelihood that tanning beds are to be found in ‘health and wellness’ facilities.1 She commented: ‘there is clear and simple advice available on the dangers of tanning beds and as clinicians we should continue to reinforce this’.

The second memorable detail from my reading? The name of the ‘Sonic Hedgehog’ signalling pathway, which is dysregulated in BCC tumour cells. My fond memories of 90s computer games highlights that information which resonates may be more likely to stick, and this could be extrapolated to sun protection advice.

For example, Dr Mariel James writes that ‘intermittent sun exposure conveys the largest risk [of melanoma], particularly when associated with burning’ – this reflects typical exposure for most UK patients. Dr James adds that sun exposure on sunny holidays abroad is a ‘key modifiable risk factor’, ‘but sun exposure in the UK should also be considered important.’

I think this is crucial to emphasise to patients who may not approach our UK summers with the same caution as they would a foreign holiday. Perhaps we need a slogan warning of the dangers of sun exposure in the UK as memorable as the ‘Slip, Slop, Slap’ campaign in Australia.

Dr James added that those who have used a sunbed before the age of 35 years are at particularly increased risk of melanoma and – I was surprised to learn – that this effect has been seen with even a single use. Considering the study mentioned earlier, Dr Chinthapalli noted that there was a higher prevalence of tanning bed use in adults over 45 years, ‘which hopefully reflects attempts to increase education around the risks’.

People of colour need tailored advice too, with different clinical presentations and risk factors to white people. Skin cancer in skin of colour is covered in-depth in this learning module and this free conference report.

For more on skin cancer, explore the modules linked in this post, or watch our free, on-demand webinar with GPwER in dermatology Dr Suneeta Kochhar.

You may also be interested in attending MIMS Learning Live South, taking place at the ILEC Conference Centre in London on 13th June 2025, where Dr Stephanie Gallard, dermatology GPSI and PCDS Executive Committee member, will speak on management of sun-related skin damage. Book your place now.

1. Diehl K, Breitbart EW, de Buhr Y, Görig T. Tanning bed use in Germany between 2015 and 2022: Representative data of 28,000 individuals on indoor tanning, risk awareness and reasons for use. J Eur Acad Dermatol Venereol 2024; 38(4): 732–40.

Keep up-to-date and get inspired at MIMS Learning Live in June

8 May 2025

Pat Anderson, editor

I am looking forward to our flagship learning event MIMS Learning Live South, which takes place on 13 June. This event, at the ILEC London, is held every summer and provides GPs with a fantastic day of primary care-focused learning. It always has a real buzz and it’s so interesting to meet GPs and hear their questions to our expert speakers.

We’ve designed the programme so that everyone gets a morning of focused, specialised learning in one of three streams (cardiovascular-renal-metabolic medicine, women’s health or dermatology) followed by a mixed afternoon of clinical topics relevant to GPs.

Our stream chairs are all experienced GPs, familiar with everyday clinical practice, who will give you practical take-home points from their specialty areas.

• Professor Raj Thakkar will chair the CVRM stream and will speak on the management of heart failure with preserved ejection fraction in primary care.
• Dermatology chair Dr Stephanie Gallard will focus on sun-related skin damage (including actinic keratosis) in her talk.
• Dr Olivia Hum, women’s health chair, will talk about menopause and breast cancer risk as part of the women’s health morning.

There are lots more topics on the programme, which will help you to improve your clinical practice, support patients, and gain CPD hours for appraisal.

Just a few of the highlights include:

• A talk on abnormal vaginal bleeding, including bleeding in women taking HRT, by GP Dr Lindsey Thomas.
• Frailty identification and management, from Dr Alistair Robertson, GP with a special interest in frailty.
• Applying the new British Asthma Guidelines in clinical practice, by respiratory GP Dr Steve Holmes.
• Childhood bugs and drugs: a paediatric infectious diseases update, from paediatrician Dr Justin Penner.

I am looking forward to seeing you there - I’ll have the pleasure of giving a short welcome from MIMS Learning as part of the event. Please do come and say hello and let me know if there are any learning topics you’d like to see covered in our e-learning modules, podcasts and live events.

Bowel cancer awareness: not just for April

29 April 2025

Sangeeta Krishnan, medical editor

April being bowel cancer awareness month, this cancer has been on my mind lately.

It is alarming to see a rising incidence of bowel cancer among the younger population. This is no longer a cancer of older people alone. Colorectal cancer is rapidly becoming one of the leading incident cancers, and (according to Globocan 2022 statistics), together with lung, female breast, and prostate cancers, it is responsible for nearly two-fifths of the overall incidence and mortality burden.

What also strikes me are the global disparities. A steady increase has been seen particularly in countries undergoing rapid economic growth, and it is an indicator of socioeconomic development. It has made me wonder why some countries experience significantly higher rates than others. The GLOBOCAN 2022 statistics suggest that a higher intake of animal-source foods and sedentary lifestyles, leading to increased overweight and obesity rates in these countries, are likely to be contributing factors.

Despite the rising incidence, hope prevails in all the exciting advances in research. Several new therapies are emerging, alongside more research establishing the efficacy of existing treatments. From annual gastroenterology conferences, I come away with more news and exciting developments, such as liquid biopsies and AI-guided detection, and research into faecal microbial transplantation (FMT) – which, while still in the early research stage, hints at the potential of harnessing the gut microbiome for therapeutic benefits. Having majored in microbiology, I find this area particularly fascinating.

The risk factors for this cancer in particular, are well-established. The World Cancer Research Fund (WCRF) discusses strong evidence linking red meat, processed meat, alcohol, and being overweight and obese to increased colorectal cancer risk. Conversely, being physically active, and consuming foods containing fibre, whole grains, dairy products and calcium supplements is linked to decreased colorectal cancer. If patients were clear about these risks, it may contribute to decreasing overall incidence of a new cancer.

FIT testing has rolled out in the NHS, with its use in the community having the potential to reduce late diagnosis and death. GPs are also getting to grips with the nuances of FIT testing for symptomatic patients - a topic explored by Dr Pipin Singh in one of this month’s podcasts. Research shows that cancers detected on screening had a more favourable stage distribution and prognosis than cancers detected otherwise.

In younger symptomatic patients, GPs may not automatically suspect colorectal cancer. However, because the incidence of early-onset colorectal cancer is increasing, it may make sense for them to bear this in mind as a possible differential diagnosis.

Bowel Cancer Awareness month may be at an end but we all need to stay vigilant.

Build your confidence around when to wait and when to refer

15 April 2025

Pat Anderson, editor

As one of our GP advisers recently reminded me on a call, time is a diagnostic tool in general practice. GPs frequently need to organise tests and investigations or repeat appointments, which take time - but sometimes they just need to see what happens over time in order to get nearer to a diagnosis.

Time inevitably passes while patients are waiting for test results, or specialist appointments. I am told that for patients who need to transfer between specialist pathways, or who have incidental findings on scans or x-rays, the time taken to navigate and re-navigate complex NHS systems can mount up very quickly.

This of course raises the possibility that a serious diagnosis such as cancer could be missed - but the problem is also compounded if specialists are receiving extra referrals because GPs aren’t feeling confident enough about watching and waiting.

As part of our Patient, Presentation, Pathway for Cancer campaign, we’re holding two webinars that should help to boost your confidence about symptomatology, when to refer and how to support your patients through complex NHS systems.

• Skin cancer: diagnosis and management. This webinar, on 23 April 2025 at 7pm, brings you tips on early diagnosis of skin cancer and outlines what primary care professionals need to know about management. Enrol now.

• Case-based discussion: better cancer outcomes. Join GP Dr Pipin Singh and oncologist Dr Pauline Leonard for a case-based discussion that will elicit learning points to empower GPs and enable better navigation of specialist pathways. 7 May 2025, 7pm. Enrol now.

I’m really looking forward to these webinars and hope you can join us. We hope to help you to spot serious cases that need urgent action, ensure patients don’t fall through the gaps, and be more confident about when ‘wait and see’ is the most beneficial approach.

The invisible workforce: shining a spotlight on carers

9 April 2025

Hayley Taylor, senior web producer

Why didn’t Aisha attend her appointment with the GP? She is experiencing pain in her knees and back, so she needs GP advice. However, as Professor Carolyn Chew-Graham explains in a module about missed appointments, Aisha did not feel she could leave her husband on his own, as he has diabetes and recently had a stroke.

Aisha is not alone in her situation. As stated by Carers UK, an estimated 5.8 million people living in the UK are unpaid carers, with 4.7m residing in England. These individuals face a significant burden while supporting loved ones with long-term health conditions, encompassing a complex web of challenges.¹

Health impact

A carer's health can be significantly impacted, with 1 in 4 carers reporting that their health is not good. 70% of carers suffer with long-term physical and mental health conditions, disabilities or illnesses. Many carers also experience relationship strain, loneliness and isolation. Carers can also be affected by worsening physical health in relation to new and existing conditions, with 44% of carers putting off health treatment because of their caring role.

Financial impact

More than 1.2 million unpaid carers live in poverty and face challenges such as unemployment, food insecurity, low-income, benefit entitlement, and high care-related costs including assistive equipment, care services, and increased fuel expenses.

To empower you in supporting carers, MIMS Learning offers valuable resources. Professor Chew-Graham provides tips on how to support carers like Aisha so that they can access healthcare.

Dr Toni Hazell's guidance on supporting dementia patients and their carers provides a useful table listing the post-diagnostic support needs of both patients and carers. In a Clinical Update podcast episode, Linda Magistris from The Good Grief Trust provides insights on effective signposting for bereaved individuals and the value of grief cafes.

Carers Week 2025 will run from 9-15 June and this year’s campaign is Caring About Equality, highlighting the health and other inequalities faced by carers.

Reference

1. Carers UK. Facts about carers (last updated February 2025).

An opportunity to make an extraordinary difference around an ordinary event

26 March 2025

Rhiannon Ashman, deputy editor

This Mother’s Day I’m reflecting on how society – and specifically our healthcare system – views pregnancy and birth, and how best to support women and birthing people through one of the most significant experiences of their lives.

Mother’s Day can be challenging for many people, not least those who have experienced miscarriage or baby loss. In a learning module on the topic, Professor James Walker says: ‘It is important to acknowledge that miscarriage is not just a medical complication of pregnancy; for many it is also the loss of a child. Regardless of how favourable the medical outcome or promising the patients’ future prospects, grieving the loss of the pregnancy is an essential part of the care process.’

He adds: ‘Clinicians who understand and address the complexities of miscarriage can help those affected to navigate their experience.’ As well as signposting to support, he says, ‘healthcare professionals can provide resources to help people plan for any future pregnancies’.

The impact of previous experiences on pregnancy is reiterated by Kim Thomas, CEO of the Birth Trauma Association, in our guide to providing trauma-informed maternity care. She says: ‘A high number of women giving birth have experienced a previous trauma – including domestic abuse.’ She adds that trauma from a previous birth is also relatively common: ‘about 4–5% of women develop PTSD after birth – roughly 30,000 a year in the UK’.

Sensitive discussion with the pregnant person at a time when they are ready is crucial, she says. And the relationship between patient and healthcare professional is significant because ‘many women will only disclose trauma in the context of a trusting relationship’.

Clinicians understand that, while there may be ‘one born every minute’, the stakes involved, particularly for women of colour, are high. Figures from MBRRACE, published in January 2024, showed that maternal death rates in the UK were at their highest levels in almost 20 years, with Black women being almost twice as likely to die as White women.

‘By global standards, giving birth in the UK is safe, but the data reported this year should be taken as a warning signal concerning the state of maternity services and the consequences of increasing inequalities and social complexities’, a report summary said.

You can see some learning points from the report here. One point is that the focus needs to extend beyond pregnancy and childbirth. ‘Postnatal care is an important window of opportunity, yet services are not joined up; the focus on the mother’s health often falls away and women lack the support they need’, the report authors said.

A tragic example is that, according to MBRRACE, between 2019 and 2021, almost 40% of maternal deaths occurring between 6 weeks and a year after the end of pregnancy were linked to mental health conditions, with suicide being the leading cause of direct deaths. It’s clear that perinatal mental health is an area where supportive care can have a major impact. If you want to feel better equipped, we will soon be publishing a comprehensive learning module on maternal mental health by Dr Carrie Ladd.

Shortly after my first baby was born, one of the parents from our NCT class described childbirth as ‘the most ordinary, and the most extraordinary, event’. If we, as a community, can lend appropriate weight to the experience and health of people during pregnancy, birth and afterwards, there is a real opportunity to make a difference.

Neurodiversity Celebration Week

17 March 2025

Hayley Taylor, senior web producer

This week (17-24 March 2025) is Neurodiversity Celebration Week, a worldwide initiative that aims to challenge stereotypes and misconceptions about neurological differences. It’s estimated that around 15% (or 1 in 7) of people in the UK are neurodivergent, receiving diagnoses for neurological differences like autism, attention deficit hyperactivity disorder, dyslexia, dyspraxia, dysgraphia, dyscalculia and Tourette's syndrome.

In the UK, we’re witnessing a significant rise in the recognition and diagnosis of neurodivergent conditions. This trend reflects growing public awareness, enhanced diagnostic tools, and a deeper understanding of how neurodivergent conditions may present. We recognise that this rise presents opportunities and challenges for GPs and primary care teams.

To support GPs in this evolving landscape, MIMS Learning offers CPD modules on neurodiversity (see list below). In a video module ‘Thinking neurodiversity in general practice’, Dr Heidi Phillips explains her crucial role of identifying and supporting patients with suspected neurodivergent conditions in primary care, the common comorbidities that patients can present with, and outlines helpful resources GPs can access. You could try our free ‘Test your knowledge of neurodiversity’ module to help you identify any gaps in your learning.

Explore the further resources provided below, and if you require specific content to support your practice, please don't hesitate to send a content request to support@mimslearning.co.uk. We look forward to hearing from you.

Further resources on MIMS Learning

Autism spectrum disorder: clinical review
Mental health conditions in autistic children and adolescents
Spotlight on ADHD
Thinking neurodiversity in general practice with Dr Heidi Phillips
Tourette syndrome and other tic disorders in children and adolescents

Targeted lung health checks: 2 ‘huge shifts’ and 1 big challenge

12 March 2025

Rhiannon Ashman, deputy editor

As of last month, NHS targeted lung health checks are now known as the NHS Lung Cancer Screening Programme. You may or may not yet have access to this, but, if you work in England, you soon should, with full roll-out planned for 2029.

Shift 1: 75% of cancers diagnosed early

To date, over 1 million people have taken part in lung cancer screening, resulting in over 5,500 lung cancer diagnoses. Incredibly, more than 75% of these cancers were detected at stage 1 or 2; a substantial increase on the 25–30% likelihood of diagnosing early-stage lung cancer via a symptomatic presentation. Roy Castle Lung Cancer Foundation says: ‘This is phenomenal and turns current early detection rates on their head’.

Speaking on our Clinical Update Podcast, Professor Peter Johnson, National Clinical Director for Cancer at NHS England, explains how the programme employs a proactive case-finding approach, inviting individuals with a history of smoking for a consultation to assess their cancer risk. Those meeting a certain risk threshold are then invited for a CT scan at a convenient location, often using mobile scan units in community settings.

And, he says, this has been ‘enormously successful’, leading to ‘a huge shift in the stage of diagnosis’.

This huge shift is not just in the stage at which lung cancers are diagnosed, but also – fascinatingly – in the profile of the patients benefiting.

Shift 2: Inverting the disparity

Professor Johnson describes the ‘remarkable effect’ of targeted screening in areas of greatest deprivation, where early diagnosis rates have historically been lower than in more affluent areas. He says the programme has ‘inverted’ this disparity – now it is those ‘in the most deprived areas who are most likely to be diagnosed with early stage lung cancer, because we've been using this screening programme specifically to target those populations.’

‘What it tells you is that if you put in the resources and you put the effort into contacting people and being proactive about offering them access to diagnostics, you can actually really make a difference to their life chances’, he added.

Improving public understanding

The change in the programme’s name signifies a major step in the ‘scaling up and transformation’ of the initiative, say The UK National Screening Committee. Crucially, they hope it will improve public understanding of the programme and its purpose.

Part 1 of this blog noted that some people do not take up breast or bowel screening because they are asymptomatic and don’t think it is needed. The same misconceptions prevail among those invited for lung screening. Indeed, Roy Castle Lung Cancer Foundation has developed an awareness campaign to tackle this precise issue.

Lung cancer screening has been a shining success in the landscape of earlier cancer diagnosis. As it becomes more widely available over the coming years, healthcare professionals have a key opportunity to educate patients and provide accessible information to continue the incredible progress seen so far.

Part 1 of this blog considered barriers to breast and bowel screening uptake.

MIMS Learning’s Patient, Presentation, Pathway for Cancer campaign provides learning and empowerment for GPs and other primary healthcare professionals around identifying at-risk patients, spotting signs and symptoms of cancer, and making best use of referral pathways to optimise early cancer diagnosis. Take a look at the free modules, podcasts and webinars available here.

Further reading

UK National Screening Committee. Targeted Lung Health Check Programme renamed the NHS Lung Cancer Screening Programme. 31 January 2025.

MIMS Learning. Podcast: NHS England’s Professor Peter Johnson on optimising early cancer diagnosis. 8 January 2025.

Roy Castle Lung Cancer Foundation. Lung health checks. Accessed March 2025.

Cancer screening uptake and the power of primary care

6 March 2025

Rhiannon Ashman, deputy editor

‘NHS launches first-ever breast screening campaign to help detect thousands of cancers earlier.’ NHS England

‘NHS ‘ping and book’ screening to help save thousands of women’s lives.’ NHS England

The NHS is investing significant time and money in breaking down barriers to cancer screening and improving rates of uptake. Clearly, those who hold the purse strings feel this has potential for significant impacts.

So what do GPs need to understand about patients’ views on cancer screening, and what is primary care’s remit in encouraging uptake?

Screening uptake

Cancer screening has a clear and important role in early diagnosis; Cancer Research UK reminds us that, since 2019:

• breast screening has diagnosed around 62,600 cancer cases
• cervical screening has diagnosed around 4,400 cases
• bowel screening has diagnosed nearly 22,800 cases.

Despite this, rates of uptake are variable.

Breast screening took a significant hit during the pandemic, and although rates are rising, around a third of those eligible are still not attending. An NHS public awareness campaign launched last month encourages women to take up breast screening. They estimate that improving attendance to 80% of those eligible would lead to over 7,500 additional breast cancers being detected at an earlier stage.

On the topic of bowel cancer screening, Professor Peter Johnson, National Clinical Director for Cancer at NHS England, speaking on the Clinical Update podcast earlier this year, says that there has been ‘a progressive increase’ in the proportion of people taking it up, as a result of the switch to fecal immunochemical testing. He added: ‘We've put a lot of effort and money into raising public awareness… but it is not for everybody, and we still see about a third of people who are sent their test kits, not returning them.’

Misconceptions

According to UK-wide survey data collected by Cancer Research UK, one of the main reasons people don’t take up bowel and breast screening when invited is because they don’t have symptoms, so they think it isn’t for them. Here there is a role for primary care in mythbusting; Professor Johnson says:  ’We still have more to do with making sure that people are aware of the opportunities of screening, and there's no doubt that the role of primary care colleagues in this is really important.’

Informed choice

Cancer Research UK says: ‘Informed choice is important when it comes to screening’, adding: ‘While someone might decide that screening isn’t right for them, there are also people who might want to be screened but something gets in the way.’

Barriers

For some there are emotional, cultural, social barriers to taking up screening:

• Cancer stigma, which may particularly affect people from ethnic minorities.
• Embarrassment or discomfort around screening involving intimate body parts.
• Time and money constraints.

Primary care cannot necessarily overcome these barriers, but simply having an awareness is important. Dr Anthony Cunliffe discusses the impact of health inequalities on cancer diagnosis in more depth, and provides tips for practical steps that GPs can take to improve outcomes, in a webinar that is available for free, here.

Professor Johnson offers a final simple reminder of the power of primary care to connect with their communities: ‘People who get a letter from their GP practice inviting them to take up a screening opportunity, we know, are much more likely to take it up than [those who get] an anonymous letter from an organisation that they regard as more distant.’ Patients trust their primary care teams, and this trust can be leveraged to support patients to make those informed choices.

MIMS Learning’s Patient, Presentation, Pathway for Cancer campaign provides learning and empowerment for GPs and other primary healthcare professionals around identifying at-risk patients, spotting signs and symptoms of cancer, and making best use of referral pathways to optimise early cancer diagnosis. Take a look at the free modules, podcasts and webinars available here.

Part 2 of this blog – coming soon – considers why the lung cancer screening programme has been such a ‘remarkable success’.

Further reading

NHS England. NHS launches first-ever breast screening campaign to help detect thousands of cancers earlier. 17 February 2025.

Cancer Research UK. Health inequalities: Breaking down barriers to cancer screening. 23 September 2022.

Cancer Research UK. Almost 90,000 cancer cases caught by screening over last five years. 19 December 2024.

NHS England. NHS ‘ping and book’ screening to help save thousands of women’s lives. 12 November 2024.

MIMS Learning. Health inequalities: earlier cancer diagnosis. 20 March 2024.

MIMS Learning. Podcast: NHS England’s Professor Peter Johnson on optimising early cancer diagnosis. 8 January 2025.

50 shades of green: working smarter, not harder, to achieve sustainability

12 February 2025

Rhiannon Ashman, deputy editor

Becoming more environmentally conscious in your decision-making at work may seem like another job on your endless to-do list, but this is not about working harder, say Dr Matt Sawyer and Dr Mike Tomson on the latest episode of the MIMS Learning Clinical Update podcast, it’s about working smarter.

Sustainability in primary care is ‘not a binary of black or white (green or white), it's a graduated approach’, added Dr Sawyer, a former GP and Director of SEE Sustainability:

‘ I use the idea of 50 Shades of Green…at one end we're not green at all, at the other end we are as green as green can be. And the 50 shades means that we're just going to do something that is a bit better, is a bit more environmentally sustainable; is a bit of a deeper shade of green.’

For example, he says that ‘plastics and recycling and turning the lights off’ might be at the lower end of ‘greenness’, but these are still important. It ‘may not be at the dark green end, but it's on that spectrum’.

Sustainable prescribing

Another shade of green could be introduced when prescribing. Dr Tomson, former GP and founding director of Greener Practice, explained that around a quarter of the total NHS carbon footprint comes from primary care, of which around 60% relates to medication.

Dr Tomson noted that 80% of the carbon footprint of a drug occurs in the manufacturing process, and not in the transport or packaging. ‘If we're going to control climate change, then the NHS and primary care has a significant responsibility, and quite a lot of that relates to medication’.

Multimorbidity is a significant challenge for GPs. ‘We're following a protocol which is designed for a single condition’, he said, and as a result many patients are prescribed multiple medications, without necessarily fully understanding why or how they should be taking them.

‘The more we get driven to prescribe more, the higher the risk to patients. And looking at that is, I think, a really important part of being more sustainable’, added Dr Tomson.

Reducing the burden of medication requires ‘patient empowerment, patient consent, (and) patient involvement’, he said.

Be part of the way forward

The benefits of a patient-led approach are further reaching, of course. Dr Tomson said:

‘It supports the move to address inequality. It supports the move to enable people to have their consultation and for this to be patient-led, rather than the traditional, old-fashioned, patriarchal care. So it's very much part of a way forward, which fits with really important other movements.’

Dr Sawyer added that this approach is about preventing illness, health creation, and managing diseases optimally, using the least impactful method. He concluded, ‘environmentally sustainable health care is actually just good health care.’

World Cancer Day: unique needs and common goals

4 February 2025

Pat Anderson, editor

February 4 marks annual World Cancer Day, and the theme this year is ‘United by Unique’ - highlighting not only that patients have unique needs, but also that they and the professionals caring for them are united by common goals.

As part of World Cancer Day, healthcare professionals and patients from around the world are telling stories about cancer treatment and their hopes and aims for its improvement.

If you were asked about your personal experiences of cancer, either as a patient yourself or treating patients, what would you say? Sharing your thoughts locally or nationally might result in changes to local NHS services or might help to shape national conversations around cancer screening, diagnosis and treatment.

Throughout 2025, our Patient, Presentation, Pathway for Cancer campaign is providing learning and empowerment for GPs and other primary healthcare professionals around identifying at-risk patients, spotting signs and symptoms of cancer, and making best use of referral pathways.

Our latest podcast discusses World Cancer Day, and provides insights into the stage at diagnosis for a variety of cancers. We talk about symptoms and signs associated with two cancer types that tend to be diagnosed late - oesophageal cancer and pancreatic cancer.

Pancreatic cancer affects over 10,000 people in the UK each year, but may present with vague symptoms. It tends to affect older people, and new-onset diabetes in a patient aged over 65 can be a red flag.

You can read more about red flag symptoms and signs in Dr Pipin Singh’s module on pancreatic cancer. He reviews symptoms and possible presentation, history and examination, investigations to conduct and when to refer. Dr Singh also stresses the importance of safety-netting for patients whose symptoms are not deemed to be diagnostic of a specific pathology.

You can read a text version of this module or listen to it in an audio format if you prefer.

We’ll release more red flags related to haematological cancers later this year, along with other learning modules related to common and not-so-common cancers.

Keep on going through the winter storms

10 January 2025

Pat Anderson, editor

January is posing huge challenges for the GPs who - together with their colleagues - keep the NHS ship afloat. We are told by our GP advisers that they’re facing lots of extra consultations for coughs, colds and flu, and the NHS Confederation says that flu levels are at the second highest level they have been since the COVID pandemic

This has been borne out in the MIMS Learning office, where more people than usual seem to have come back from Christmas with tales of the dreaded winter lurgies.

Many people worst affected are older, and more at risk of hospital admission. GP surgeries, hospitals and A&E are extremely busy, and the pressure on NHS services is worsened by staff absence due to sickness.

We hope that the challenges will ease soon, and as always, we are impressed by the resilience of general practice and your ability to keep on going.

We have resources on infectious disease that may be helpful - including acute cough in children and pertussis, fever in adults, COVID, chicken pox and scarlet fever.

On a more positive note, we’re delighted to be welcoming Dr Farnaaz Sharief - an experienced trainer with a GP background - to a webinar on Monday 13 January where she’ll talk about how to make a positive impact on your team’s clinical practice.

If you’d like a break from the storms and a chance to think positively about the year to come, we look forward to welcoming you virtually on Monday night at 7pm.

Free CPD to help you optimise early cancer diagnosis

6 January 2025

Rhiannon Ashman, deputy editor

Throughout 2025, our Patient, Presentation, Pathway for Cancer campaign will provide learning and empowerment for GPs and other primary healthcare professionals around identifying at-risk patients, spotting signs and symptoms of cancer, and making best use of referral pathways to optimise early cancer diagnosis.

It’s estimated that a typical full-time GP will see 8-9 new cancer cases per year. And NHS England says that of the 290,000 cases of cancer diagnosed in the UK each year, most will come via a symptomatic presentation to primary care.

Of course these figures are the tip of the pyramid – for every cancer diagnosed, there will be many challenging consultations, and many referrals.

We know that cancer weighs heavy on the minds of everyone working in primary care, and the NHS as a whole. Indeed, the current NHS Long Term Plan makes cancer a priority, aiming to ‘build on work to raise greater awareness of symptoms of cancer, lower the threshold for referral by GPs, accelerate access to diagnosis and treatment and maximise the number of cancers identified through screening’.

That’s why we want to support you with free learning content – including red flag symptoms for certain cancers, webinars to hone your skills at spotting symptoms and safety netting, and podcasts offering insights from the experts on navigating referral pathways. New modules will be added regularly, focusing on the three key pieces of the cancer diagnosis puzzle where primary care can have the greatest impact:

• Patient: at-risk patients need to be identified and encouraged to engage, and we will highlight ways for GP practices to pursue this, as well as safety netting where appropriate.
• Presentation: GPs need to be able to spot the signs and symptoms that should prompt referral, and have cancer at the front of mind – so we’ll provide learning around this.
• Pathway: patients need to see the right specialist and our learning will help GPs to optimise referrals and make best use of local pathways.

Find out more, and take a look at the free CPD available, here.

What are we most proud of this year?

17 December 2024

Rhiannon Ashman, deputy editor

As 2024 draws to a close, we’re feeling reflective! Here are MIMS Learning’s five proudest achievements of the year. We hope you can also take a moment to reflect on all that you have learned, and how you have developed – personally and professionally – over the past 12 months.

1. We’re proud of you

Whether you’re a GP, nurse, pharmacist, hospital doctor or other healthcare professional, MIMS Learning is here to support you, so our number 1 proudest achievement of 2024 is that our learning modules have been completed just under 200,000 times this year! That’s an incredible amount of learning and reflection about clinical practice, completed at a time of great pressure in the health service. You are all amazing learners!

2. Targeting health inequalities

This year we have given lots of (virtual and mental) space to the crucial issue of health inequalities, and we’ve been delighted by your response. Some of our most popular modules of 2024 have been part of this campaign, including learning on equity in maternity care (this module alone has been completed by over 1,800 of you), transgender healthcare, coronary artery disease in women, prison healthcare and foetal alcohol spectrum disorder. There’s still chance to read these modules – and more – for free, until 6 January 2025, so don’t miss out!

3. Our long list of shortlists

It’s always nice to receive external recognition for your hard work, and this year MIMS Learning was shortlisted for a number of prestigious industry awards, including ‘Learning Platform of the Year’ at the Learning Awards, ‘Best Science & Medical' podcast at the Publishers Podcast Awards and ‘Best Publisher-led Social Good Initiative or Campaign’ at the Association of Online Publishers Digital Publishing Awards, to name but a few.

4. The rise and rise of the Clinical Update podcast

2024 has been the year that we shook up our podcast, releasing a new episode every week and interviewing some brilliant guests. Our most listened to episode featured a discussion about ear symptoms, including hearing loss, acute otitis externa, red flags to look out for, and supporting patients with tinnitus.

5. Making the commute work for you

We’re proud to produce valuable content to enable you to learn at a time and place that suits you. Here’s what Dr Suchtira Chinthapalli, MIMS Learning’s clinical adviser for dermatology, had to say on the topic.

Please do keep giving us your feedback, as it helps us to make a better learning product for you.

Wishing you a very happy new year, from all of the MIMS Learning team.

Five early signs of frailty and 5-weekly reviews to optimise care

4 December 2024

Rhiannon Ashman, deputy editor

Despite knowing that the UK has an ageing population, I was still shocked to read in a report by Age UK that the number of people over the age of 75 years in England has grown by almost 21% since 2013. The report goes on to say that ‘the number of full-time equivalent GPs (including trainees) increased by just 2.5% between March 2023 and March 2024’, and this is ‘not keeping pace with the population growth of older people’.

This report reinforces what we at MIMS Learning have become increasingly aware of this year – that GPs have less and less time to spare on simpler, time-limited illness and are almost wholly focused on complex, often older patients, who have multiple comorbidities, and may be taking multiple medications.

At MIMS Learning Live, back in June, we spoke to Dr Pipin Singh, who works as a GP partner in Tyne and Wear. He said:

‘As we all know, as GPs, the volume of work has gone up. The complexity of the work has gone up. The 10-12 minute appointment time is just no longer fit for purpose. It was designed many moons ago when you probably could get through a lot more cases in that amount of time, which I think we're all struggling to do these days.’

The Age UK report calls for more investment in primary care and community services to tackle this issue. But, with no control over the national purse strings, what can GPs do to optimise care for older patients?

Speaking on our Clinical Update podcast, Dr Alistair Robertson, London GPwER in frailty, said that as a starting point, everyone in the practice should have frailty on their radar. He outlined five early markers to look out for:

1. unintentional weight loss
2. self-reported tiredness
3. weakness measured by grip strength
4. walking speed
5. low physical activity.

Of these, he says that walking speed is ‘probably the most sensitive one’, adding that ‘something as simple as watching a patient get up from their chair, walk across the waiting room towards a doctor's office alone could be a marker of frailty.’

Dr Robertson said that it takes time to address frailty, but that as well as providing better care for patients, `ultimately you can save time’. He says: `In the frail population, really less is more. It’s all too easy to fire off a FIT test and before you know it, you’ve got letters going out for colonoscopies and all sorts. So this is all about stopping that chain of events that can happen … saving your colleagues time and saving your local services money.’

In another podcast episode, Dr Singh (who is the practice lead for his local nursing home) explained that he adopted a 5-weekly cycle of reviewing each nursing home resident ‘that allows for scheduled and unscheduled care’. He added that, before adopting this process ‘unscheduled care amounted to around two to three patients a day, plus queries’. But, ‘the ward round often prevents queries coming throughout the week. Because I tend to mop up all of that on the ward rounds, my colleagues won't get any of those queries coming through. So overall it improves workflow and efficiency’, he said.

In both of these interviews, Dr Robertson and Dr Singh go on to talk about practical steps to optimise care for frail older people, which might include looking at polypharmacy and whether medications can be rationalised, making best use of your practice team, and putting in place advance care plans with patients and their families. If this is a growing issue you’re facing in your practice, I would definitely recommend a listen to these two episodes in full.

Prostate cancer: what is the way forward for picking up harmful cancers earlier?

21 November 2024

Pat Anderson, editor

The release of our recent Clinical Update podcast episode about prostate cancer, featuring Professor Mike Kirby, coincided not just with Movember (an annual event to raise awareness of men’s health issues), but also with a flurry of news stories about prostate cancer screening.

At the moment, NHS guidelines for England say that anyone who has a prostate can request a prostate specific antigen (PSA) test if they are over 50 years old. However, it was widely reported in November that health secretary Wes Streeting had asked the NHS to look at the case for lowering the age at which the test is available.

The risk profile for prostate cancer is complex, but ethnicity has a notable part to play. Black men are at higher risk of prostate cancer, with one in four developing the disease. There is also risk associated with family history of certain cancers.

In our podcast interview, Professor Kirby said: ‘Let’s do a PSA test on all men with a family history of prostate cancer or a family history of ovarian or breast cancer because of the link with the BRCA1 and BRCA2 gene. And actually also if there’s a family history of pancreatic cancer or colon cancer, the risk of prostate cancer is actually raised.’

He talked about the Prostate Cancer Research charity, which has run a petition on targeted prostate cancer screening as part of its `Proactive for your Prostate’ campaign. The charity says that changes to clinical practice over the last decade mean that, at a minimum, a targeted screening programme for those at higher risk should be introduced as soon as possible.

At present, there is no national screening programme for prostate cancer in the UK, because of the limitations of PSA testing. It is not regarded as reliable enough to pick up cases of cancer that need treatment at an early stage.

However, a combination of blood testing and other information, such as family history, may show more promise. Professor Kirby points out that developments in investigation – with more use of MRIs – and improved treatment mean that the consequences of a diagnosis of prostate cancer are different than they used to be. There is more `active surveillance’, for example, for men who have less aggressive prostate cancer.

It will be interesting to see what the UK National Screening Committee recommends in future. More public attention on the issue may not mean immediate changes to national policy, but it could result in more men coming to their GP for PSA testing if they have a family history.

Skin, hair and nail changes: the canary in the coal mine

6 November 2024

Rhiannon Ashman, deputy editor

We all know that the skin is the largest organ of the human body, but how does what’s happening on the inside, show up on the outside?

Dermatological symptoms of systemic illness

In preparation for the latest episode of our Clinical Update podcast (which you can listen to here), I started researching dermatological symptoms of systemic illness. Looking back through our catalogue of learning modules I realised I had bitten off more than I could chew, in choosing this as a topic for a 20 minute podcast discussion!

As I delved deeper, I turned up more and more examples of systemic illness making itself known through skin, hair or nail changes.

For example, iron deficiency anaemia may present with generalised pruritus, oral ulcers and angular cheilitis, as well as skin or mucosal pallor, whereas B12 deficiency is associated with skin hyperpigmentation (especially over hands and feet).

Hair loss might indicate hormonal problems, diabetes, or autoimmune diseases, while hirsutism can be linked to ovarian or adrenal tumours, and Cushing’s syndrome.

And cutaneous manifestations of inflammatory bowel disease are common – for example, erythema nodosum occurs in 15% of patients with Crohn’s disease – according to a presentation at the European Crohn’s and Colitis Organization’s 2023 symposium, which MIMS Learning reported on.

Early warning system

What stood out was how dermatological symptoms may appear before other, perhaps more specific, symptoms, acting as an early warning – the canary in the coalmine.

This is especially relevant for serious conditions that are tricky to spot. Take Hodgkin and non-Hodgkin lymphoma; I learned from a module on skin problems in haematological disease that 15–30% of patients are affected by pruritus and the itching can precede other symptoms.

Similarly, 50–80% of patients with pemphigus vulgaris have oral lesions, which may precede the distinctive skin lesions by over a year. Dr Matthew West who wrote for MIMS Learning on the topic said that spotting these signs can allow ‘early recognition and appropriate referral for a condition that, if left untreated…can be fatal’. Oral lesions can also be the first clinical sign of Crohn’s disease and may even ‘precede gastrointestinal symptoms, especially in children’, he said.

And let’s not forget that cutaneous signs can be the outward manifestation of psychological distress. This is discussed in a case study of a 56-year-old man with facial erosions, scars and pigmentation who, after initially being misdiagnosed with seborrhoeic dermatitis, was found to have acne excoriée (a form of skin picking disorder). The module authors said that the condition is ‘associated with various psychiatric comorbidities, such as depression, anxiety, obsessive-compulsive disorder, body dysmorphic disorder, or social phobias’.

When faced with skin, hair or nail changes, remembering the canary in the coalmine might just help us to spot something going on beneath the surface.

Juggle’n’ride a little more easily with MIMS Learning Live North this December

17 October 2024

Pat Anderson, editor

It must be a huge challenge for GPs to keep on top of all the clinical topics that they need to know about - each patient presents a unique challenge, and may present you with a learning need as well as their history.

To me as an external observer, it all sounds a bit like juggling while riding a unicycle. Your job requires working under pressure with good observation, not letting anything fall through the net, and keeping a sense of direction through a changing environment.

At MIMS Learning Live in Liverpool on 4 December 2024, we offer you the chance to put down the clubs and park the unicycle for a day, and focus on a set of key topics that will help your day-to-day practice.

Programme highlights

At the event you can choose from two streams. Stream A provides updates on subfertility, mental health, cardiovascular medicine and men’s health, while Stream B covers dermatology, women’s health, neurodiversity and oncology.

Registration is free and our expert chairs are GPs themselves, so they’ll help to ensure that the focus is on what’s relevant to GPs.

This December’s programme content is informed by feedback from delegates and insights from our primary care clinical advisers.

Speaker highlights

Cancer: a key topic identified by our GP advisory team is diagnosis of haematological cancers, which are relatively common but present a diagnostic challenge, as symptoms can be vague. To this end, we are delighted to have Dr Majid Kazmi joining us.

Dr Kazmi is consultant haematologist and deputy medical director of Guy’s and St Thomas’ NHS Foundation Trust, and will provide tips on what to look out for in a background of non-specific symptoms.

Dermatology: on the dermatology side, we’re delighted to welcome Dr Stephanie Gallard, who is a GPSI in dermatology and Primary Care Dermatology Society executive committee member. Her talk, `Eye eye! Common dermatology problems around the eye’ will cover recognition, diagnosis and management of common dermatological problems seen in the skin around the eye, and pointers for onward referral.

Women’s health: Professor Carolyn Chew-Graham will look at the impact of perinatal mental health difficulties on women, infants and families, and the range of management options in primary care. Mr Mageed Abdelrahman will cover heavy menstrual bleeding, including causes, management options and when to refer.

Sexual health and fertility: Professor Mike Kirby will explore lower urinary tract symptoms in men and their relationship to sexual health, while Mr Abdelmageed Abdelrahman will discuss subfertility and its causes, along with referral options.

Lipid management: a concise update on the lipid targets to aim for and how to use newer agents for lipid management will be the focus of Dr Pipin Singh’s talk.

Neurodiversity: last but by no means least, Dr Heidi Phillips will present a session that will equip you to better understand what is meant by neurodiversity and enable you to better support neurodivergent patients.

A buzzy and enjoyable day

Our delegates always tell us how much they enjoy our events, so come along and see for yourself! It’s a chance to network with colleagues and visit our exhibition - all part of the clinical learning experience.

We hope you’ll feel energised and ready to get back in the saddle after your day. Looking forward to seeing you there!

Find out more.

Small steps to big change: embedding social prescribing into primary care

2 October 2024

Rhiannon Ashman, deputy editor

Anxiety, loneliness and isolation can seem insurmountable. But small steps in the right direction can make a big difference.

I've recently joined a ‘wellness walking group’. Having had a baby, and moved house (twice) in the past two years, I wanted to meet people in my community and get more exercise – this walking group has been a wonderful way to do both. Many members have joined to take some literal, and metaphorical, steps towards improving their mental health.

Up to one-third of people will be affected by an anxiety disorder in their lifetime, according to a clinical review on generalised anxiety disorder. And on the advice of our mental health adviser, we have a learning module planned on loneliness (keep an eye out for this later in the year). It’s no wonder my walking group is oversubscribed.

Bridging the gap

I spoke to Monica Boulton from the National Academy for Social Prescribing on our Clinical Update podcast. She outlined the role that social prescribing can play for people experiencing struggles:

‘What social prescribing link workers are able to give, which doesn't really exist within our NHS at the moment, is time, is the time to really understand the social determinants of health, the time to really understand not just the symptom that that patient might be presenting with, but the cause and where that might be coming from.’

She added: ‘Social prescribing link workers are often described as the bridge between healthcare and the community. And I think that's a really beautiful analogy.’

This sentiment was echoed by Dr Pipin Singh, a GP in Tyne and Wear, who said link workers are ‘bridging the gap’. He continued: ‘We are still very restricted in the amount of appointment time we can give to patients…and as we all know, as GPs, the volume of work has gone up. The complexity of the work has gone up.’ He explained that the link worker and care navigator at his practice can spend ‘more time with the patient than we can, which is sad to say, but is what has happened over time.’

Speaking of embedding social prescribing into primary care, Dr Singh said: ‘I think it's about the communication you have with them [link workers]... and making sure that they have someone to go to…if they've got concerns or if they identify something that they're not comfortable with.’

Reaching the hard-to-reach

For Monica, another strength of link workers is their ability to reach people in their communities who need it most. In the clip below, she explains why they are so well-placed.

Small steps

Describing a ‘transformational’ case from her time as a link worker, Monica illustrated how small steps in the right direction can have a big impact. This individual had ‘been in and out of mental health services her whole life’ but, after working with a social prescribing link worker to determine what really mattered to her, ‘she went from being somebody that never left the house to being somebody that was putting on her own art exhibition in a local gallery’.

So whether it’s art exhibitions or walking groups, there is great potential for social prescribing to help patients and clinicians navigate that bridge between the social and the clinical. 

To listen to the rest of my interview with Monica, click here.

The common thread linking endometriosis, menopause and pelvic floor dysfunction

24 September 2024

Pat Anderson, editor

`I had many perimenopausal symptoms, saw so many different doctors. Not one of them made the connection’.

`Prior to this diagnosis [of endometriosis], I know that I've been back and forth to my GPs countless times. I felt like I was being constantly fobbed off.’

Endometriosis, menopause and urogynaecological problems such as prolapse and incontinence affect many people in the UK.

There is some symptom overlap, and some individuals may encounter all three conditions – but the main commonality is not a sign or symptom. It’s something less visible, and was discussed in a webinar forming part of our Tackling Health Inequalities campaign.

At the webinar, speakers Dr Anita Sharma, Dr Louise Newson and Mr Abdelmageed Abdelrahman all talked about the common theme of women not being heard. This is a health inequality in its own right.

Why aren’t women heard? It appears that sometimes healthcare professionals aren’t asking the right questions, or sometimes women don’t come forward, or sometimes women just aren’t listened to when they do seek help. It takes on average 7–8 years for a diagnosis of endometriosis to be made – quite shocking when you consider that 1.5 million women experience it.

In the recorded version of our webinar, which is free to view on MIMS Learning for a limited time, our speakers revealed their passion and commitment to making a difference for women by educating healthcare professionals to ensure that the right questions are asked, that these common conditions are considered, and that referrals and interventions are timely.

The patient viewpoint

The clinician speakers were joined by Siobhan Kennett, a patient representative who has had surgery for endometriosis after `years’ of presenting to her GP with heavy and painful periods, chronic fatigue, abdominal bloating, frequent urination, and being offered only the contraceptive pill and antidepressants. After a scan revealed endometriosis on her ovaries, she waited six months to see a gynaecologist, and was told it would be 18 months before she could have surgery.

Siobhan concluded: `Between experiencing my early symptoms and eventually receiving surgical treatment and a diagnosis for endo, it was about 10 years.’

Her experience is borne out by the NCEPOD report into endometriosis published this summer, which Dr Sharma was involved with.

This report, Endometriosis: A long and painful road, found that 58% of patients surveyed had multiple visits to the GP before any investigations were undertaken or treatment initiated.

Dr Sharma presented a key slide for GPs listing symptoms to look out for. She said: `I’d like you to put that slide on your desktop, share it with your colleagues so that when you see a patient – even a young woman aged 17 and under – presenting with these symptoms, just think of endo.’

Joining the dots

Dr Louise Newson provided evidence of similar diagnostic delays affecting women with perimenopausal symptoms in her presentation. She said that women living in areas of deprivation were less likely to receive HRT.

`Generally in the UK, only about 14% of menopausal women take HRT, half of what it was 20 years ago. But in areas of deprivation, it's as low as 2%, which is really shocking.’

She said that barriers to better care included lack of education about hormones among health professionals, who tend to work in silos, with patients seeing `cardiologists for their palpitations, neurologists for their migraines, rheumatologists for their arthritis, muscle and joint pains, urologists for the urinary symptoms, and no one's joining the dots’.

Embarrassment and isolation

Mr Abdelmageed Abdelrahman said that where prolapse and incontinence were concerned, people may feel `embarrassed to talk about these things and they feel isolated’.

He said: `It's not uncommon that I hear women coming to the clinic and saying, you're the first person I've discussed this with.’

He added that GPs should ask themselves whether they were comfortable talking to patients about four key areas related to pelvic floor dysfunction, and if not, how they could introduce this into their practice to ensure women are not disadvantaged.

The four areas he outlined were: asking patients about leakage of urine; whether they could feel a bulge in their vagina; whether they experience pain with sexual intercourse; and whether they struggle with stool control.

Do have a watch of the webinar – it’s full of great insights from experienced clinicians and has the potential to change things for the better for women affected by these common conditions.

What a parenting mantra can teach us about improving vaccine uptake

18 September 2024

Rhiannon Ashman, deputy editor

This year’s whooping cough outbreak brings into sharp focus the challenge of improving vaccine uptake. Our colleagues at GPonline have reported on the rise in cases of pertussis – 2,591 confirmed cases in England in May 2024 alone, compared with 858 cases throughout the whole of 2023.

In addition to concerns about the health of infants, the MBRRACE-UK confidential enquiries, published early in 2024, emphasised the vulnerability of pregnant women to infection with preventable illnesses, exacerbated by confusion around immunisation and vaccine hesitancy.

Primary care professionals know that pregnant women – and indeed all eligible patients – should be encouraged to take up the vaccines available to them. But actually effecting this change is the challenge.

Connection over correction

And so, while we rightly reject paternalism in medicine, my recent conversations with GPs have left me thinking about a mantra often used in parenting spheres: ‘Connection over correction’.

Speaking on our Clinical Update podcast, Dr Farzana Hussain, GP in East London, said of patients who were hesitant about the COVID vaccine: ‘I took the very simple approach of listening and I wanted to make sure that they had their autonomy to be able to make their own decision rather than forcing anyone to take it, but making sure that they also had medical information.’

Dr Hussain asked her patients about their concerns – she empathised, understood and respected their decisions. She added, ‘I'm quite a curious person. I'd say nosy, probably, but I don't think that's a bad quality in a GP.’

Describing the case of an 82-year-old patient who was ‘worried about the long-term side-effects’ of the COVID vaccine. Dr Hussain said: ‘Because I know her, I giggled, and I said, you know, you're 82, if in 20 years time you grow a second head, I'll chop it off for you, even though I'm not a surgeon, and we giggled about that, and it helped her get it into perspective.’

‘I said, you know, my own mum isn't here. She died when she was 57. But if she was here I would have wanted her to have it and I'd like you to have it even though you're not my Mum. And her daughter rang the next week and said, I don't know what your doctor said because I couldn't convince my mum to have it. But she went and had it.’

Continuity of care

Dr Hussain said, ‘It made me remember the power of doctor–patient relationships and continuity.’

People working in primary care are, usually, interested in people. And, although time poor, GPs often want to provide continuity for their patients. Remembering the value of ‘connection over correction’ can help primary care to harness the power of their position to effect change for patients.

‘Health professionals are often busy and I know our nurses do a lot of this counselling as well, and it's busy, but there's no substitute for genuine listening, and listening without wanting to respond.’ reflected Dr Hussain.

Read more:

Paediatric pertussis: clinical review
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