And at this point a reminder of the Naci paper. High prices = opportunity cost and lost lives in net terms This is where the primary care budget is! www.thelancet.com/journals/lan... thread here bsky.app/profile/fell...

My thought looking at this is that it wasn’t written by someone working in primary care. More and more specialists are expecting us to do more and more tests prior to referral. (And there’s more and more specialists whilst GP numbers are nowhere near keeping up)

Most penicillin 'allergies' aren't real, finds a major trial run by our CTU & led by @universityofleeds.bsky.social. 88% of patients with a penicillin allergy label had it safely removed after testing, meaning: ✅ better treatment for patients 🦠 a vital step in tackling #AntibioticResistance.

Fab thread on the ‘genomics revolution’. 1. Might be helpful for a few people with conditions that are closely genetically linked. 2. Most conditions aren’t. 3. The cost will be enormous 4. Lots of people will become unnecessarily anxious 4. Telling people their risk doesn’t change behaviour

Ministers - more health checks are not game changing, actual action on public health would be game changing as per @sebrees1.bsky.social & co bsky.app/profile/sebr... and @felly500.bsky.social hsj.co.uk/policy-and-r... and @swoolnoughtkf.bsky.social hsj.co.uk/service-rede...

For guidance, advice, campaigns and examples of good practice to tackle medicine waste and improve adherence, head over to our resources. www.prescqipp.info/our-resource... @pharmdeclares.bsky.social @tonyavery.bsky.social

Looks like a snake oil epidemic on social media: “We analysed almost 1,000 social media posts about 5 popular medical tests. Most were utterly misleading” #overdiagnosis theconversation.com/we-analysed-...

Great to speak to @peteredwards.bsky.social for the @bjgp.bsky.social podcast about safety netting in general practice. Some great tips for practice - listen here! 👇 bjgplife.com/episode-196-...

podcasts.apple.com/gb/podcast/t... here’s an 18 min chat w Jonathan about statins in older people. Maybe you know someone like Mrs Evans …

**NEW BMJ PAPER** "Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches" - most models provide just a risk estimate - we argue for presenting associated uncertainty too - includes pros, cons, PPIE & methods Hope helpful! www.bmj.com/content/388/...

What is best practice for giving 'safety netting' advice to parents of acutely unwell children in general practice & what role might AI play? Mavin Kashyap, Damian Roland & Peter Edwards consider the evidence in this recent @bjgp.bsky.social editorial. bjgp.org/content/75/7... #GPsky #PrimaryCare

Implementation of clinical pharmacists in #PrimaryCare resulted in improvements in prescribing quality, with reductions in the total number of opioid prescriptions and total costs of medicines per patient  doi.org/10.3399/BJGP... 

Glad this group have published this thoughtful challenge to current practice. We’ve lost our way somewhat and we wont get back on track without strong and reasoned voices.

Mandatory training has lost its way. Once a tool for learning critical skills, it's now a growing list of endless requirements. If everything is mandatory, is anything truly essential? 🧵

It’s Twixmas! Why not catch up on some of the great medicines related chat you have missed out on in 2024. Some of our best episodes and fun-related CPD guaranteed.

ICYMI - the world of medicines in 2024 Wrapped by the five apothecaries!

I agree. www.bmj.com/content/387/... Direct access to Knee MRI from GP is not, on the whole, helpful. I don't have access and don't want it. Same with back and head MRI. I can honestly say I can't order them so don't have to engage in long and fruitless conversations about why they aren't indicated

Important piece by @lucypgeridoc.bsky.social et al in @bmj.com this week. We need better data on harms and benefits of heart failure treatments in frailty to inform SDM. Pts deserve better www.bmj.com/content/387/...

NEW BRIEFING by @becksfisher.bsky.social in collaboration with Health Equity Evidence Centre calls for the outdated GP funding formula to be replaced by a needs-based payment to better address health inequalities. 💷 Read here: www.nuffieldtrust.org.uk/resource/fai...

I’ve heard about 2 ‘referral management’ services in the past week that are clearly designed to keep patients away from waiting lists. Problem is, the experience of the patients I’ve heard from has been appalling. Reminder: It is possible to provide *person centred care and reduce waiting lists*

This is a great paper, thanks for posting Tom. It's not good enough for risk prediction tools to be accurate. We must demonstrate that their use is clinically useful and cost-effective before adoption.

Love how Bluesky put these two posts together for me….. Do read @ritamc.bsky.social excellent thread on why private primary care is not the answer.

@bjgp.bsky.social @rcgp.bsky.social read Iona Heath’s BJGP Editorial from 20yrs ago on pitfalls of #physicianassociates & particular issues for deprived areas & inverse care pmc.ncbi.nlm.nih.gov/articles/PMC... we need more GPs particularly in deprived areas!

Cautionary tale about potential harms of guideline-based care (more harm with intervention to treat to guideline) … OR … Shining a(nother) light on the magic sauce of longitudinal primary care (versus focused pursuit of surrogate measure targets) 🤨 www.nejm.org/doi/full/10....

@clarepharmacy.bsky.social might say "A bit blokey " but one of our most edgy and thought provoking podcasts re NHS systems #pharmsky

Here's @drkevinfernando.bsky.social latesst article, co-authored with the Guideline's team, covering key take-home messages & implications for primary care from the recently updated ESC hypertension guidelines rbnc.cc/hyp24

The debate on assisted dying has been, on the whole, thoughtful and considered. It’s complex and important. I do wonder whether those opposing assisted dying are, sometimes, holding onto a degree of medical paternalism of a bygone era.

Good initiative! We published an introduction to instrumental variables article in JCE www.jclinepi.com/article/S089...

Does anyone else find pts statins being stopped in hospital because of “deranged lfts” - with GP to consider restarting in the community. I’m not sure of the logic of stopping. The statin sure as hell isn’t causing the LFT issue. Is it unsafe to continue? #medsky

www.newstatesman.com/politics/hea... #surdiagnostic #overdiagnosis Applies across life. Dying patients express a range of emotions; sadness may predominate. "Please order an anti-depressant" wrote the nurse. "I'd start an SSRI" says the med student. Or, maybe, just maybe, this sadness is okay.

Gave a lecture today for some Med students. Gathered some instant feedback using polling software…. My kids tell me it’s good 🤨

Great HSJ podcast with @davewwest.bsky.social this week. Sensible suggestions from guests on 10-year plan. One thing 'a leading trust CEO, ICS leader and policy guru' all agree on is invest in primary care. Perhaps needs someone form primary care at the table? www.hsj.co.uk/hsj-health-c...

Let’s not reduce the art of seeing unwell children to a process of “medicine by numbers” pleads @helensalisbury.bsky.social in the @bmj.com this week. More reasons to cherish relationship based medicine as discussed by @francesmair.bsky.social recently. #GeneralPractice #MedSky #PaedsSky

1. Many doctors recommend treatments for their patients that they wouldn’t necessarily take themselves. 2. Clinicians & patients tend to overestimate treatment benefits and underestimate harms. 3. Perhaps 20% of health spend is wasted Yet we are pouring £200 billion into the NHS next year. Hmmm

I just hard reason to check the spam folder of my academic email address. Wow, that filter is doing some work! I get annoyed at the amount of academic spam I receive but feel a bit better knowing how much doesn't get through. Small things....

New to #Bluesky? Join our #deprescribing starter pack. Perfect for #polypharmacy, #medicationoverload, #medicinesoptimisation, #medicationappropriateness, #deprescription, #lessismore friends! DM or reply to be added. go.bsky.app/6MA8eQA

Slowly dipping my toes into research. First substantial offering: bmjopen.bmj.com/content/14/3... We interviewed 12 experts in British Columbia to explore why patients get unnecessary & harmful things, and what helps to avoid this #choosingwisely #quaternaryprevention #lessismore #sensiblemedicine

New platform, new opportunity to repost some recent blogs. Have done a lot on the Primary Secondary Care Interface and have learned that No one is Trying to do a bad job… drjongriffiths.wordpress.com/2024/05/10/n...

Yessssss! Journal editors and board members let’s do this! Folks on academic org committees! We can make the case to at the very least change the “Your Twitter handle” box on everything to something like “Your social media profile” #commsky I for one would be thrilled by “Share to Bluesky”

“Overtreatment of men with limited longevity for intermediate- and high-risk tumors has not only failed to improve but has actually worsened over the last 20 years,” rbnc.cc/over @mgtmccartney.bsky.social

Agree Sam. Evidence suggests we only describe likelihood of benefits and harms and ask patients about ‘what matters’ in about 3-4 in 10 consultations. NHS Resolution ‘failure to inform’ claims (tip of the iceberg) are still going up. Are we focussing too much on elective throughput I wonder?

For those interested in #SDM - it's well worth reading this brief and thought provoking essay. journals.sagepub.com/doi/10.1177/... (HT @glynelwyn.bsky.social ) #MedSky

Interesting commentary on polygenic risk scores (for CVD). I'm sceptical here. We have risk prediction that is good enough (but not used well enough). The vogue for PRSs is, IMO driving by $s not health. It creates a new market, and keeps researchers in business! jamanetwork.com/journals/jam...

@jonnyunderhill.bsky.social you were asking about smoking cessation DST (on another forum!) I don't know of one, but there is good info on NHSCT which could form the basis of one: www.ncsct.co.uk/library/view...

I’ve made the move! For those who knew me from the other side, please follow. Looking forward to some stimulating and productive discourse for a change!