Pelvic floor symptoms, such as lower urinary tract symptoms, defecation problems, sexual dysfunction, pelvic pain, and pelvic organ prolapse in females, are common and frequently co-occur. Despite negatively affecting quality of life, few patients seek help. Most studies assessing help-seeking behaviour have focused on a single pelvic floor symptom. We aimed to explore the barriers and facilitators of help-seeking behaviour in males and females with at least two pelvic floor symptoms. This interview study included participants based on age and symptoms (number and type) from a larger group taking part in a survey on pelvic floor symptoms in the general population. Two researchers independently encoded and analysed the semi-structured interviews, continuing until saturation for both the male and female cohorts. Of the 25 participants (13 male, 12 female), 9 sought help for all of their pelvic floor symptoms, 10 did not seek help for any symptom, and 6 sought help for some of their pelvic floor symptoms. We identified themes in domains related to the patient, healthcare professional, environment, and symptom. Although most themes applied to both males and females, some had greater sex specificity. Males and females have more similarities than differences in help-seeking behaviour. Healthcare providers should be aware that patients who seek help for one symptom probably have multiple pelvic floor symptoms that the patient has not reported.

In the summer of 2021, after 18 months of the COVID-19 pandemic, there were still no clear evidence-based interventions for COVID-19 infection in the community. Recruiting large numbers at pace was a challenge to urgently generate the evidence needed to inform care within the pandemic. To develop efficient, user-friendly recruitment methods to offer large numbers of acutely unwell, infectious people with COVID-19 UK the opportunity to participate in a priority trial and test the clinical and cost-effectiveness of molnupiravir. PANORAMIC was an adaptive platform clinical trial with participants randomised to either a novel antiviral or usual care. Participants needed to start antiviral medication within 5 days of symptom onset. Innovative methods of identifying positive individuals within general practice were developed, as well as online research procedures for delivery and follow-up, including through www.panoramictrial.org. Novel methods of recruitment were developed in collaboration between the study team and the NIHR Clinical Research Network (CRN), and continually adapted during the study. These included virtual recruitment through the study website combined with GP recruitment via hub and spoke models: this was supported by data, stakeholder, and workforce infrastructure across devolved administration. PANORAMIC was the fastest recruiting study ever delivered by primary care in the NIHR CRN. There were 26 411 participants recruited. Final molnupiravir results will also be presented. Large-scale, at-pace recruitment supported by the English CRN and equivalent networks across the UK, is achievable in a pandemic situation, producing potentially game-changing results of national and international importance.

As academic clinical fellows (ACFs) in general practices across London we are stakeholders in general practice at the outset of our careers. We recently discussed our concerns about the future of general practice and our futures in the speciality at our regional teaching session. Here is a summary of what we discussed:

Cancer is predominantly a disease of older adults. To date there has been little research on the experiences of older adults or their views on the diagnostic pathway. To gain an improved understanding of the views and experiences of older adults on all aspects of cancer investigation. This was a qualitative study using semi-structured interviews with patients aged ≥70 years. Patients were recruited from primary care in West Yorkshire, UK. Data were analysed using a thematic framework analysis. The themes identified in participants' accounts included the patients' process of decision making, the value of having a diagnosis, the patients' experience of cancer investigations, and the impact of the COVID-19 pandemic on the diagnostic pathway. Older adults in this study indicated a clear preference for having clarity on the cause of symptoms and the diagnosis, even in the face of unpleasant investigations. Patients suggested they wanted to be involved in the decision process. Older adults who present to primary care with symptoms suggestive of cancer may accept diagnostic testing solely for the benefit of knowing the diagnosis. There was a clear patient preference that referrals and investigations for cancer symptoms should not be deferred or delayed based on age or subjective assessments of frailty. Shared decision making and being involved in the decision-making process are important to patients, regardless of age.

Urinary tract infections (UTIs) are a common indication for antibiotic prescriptions, reductions in which would reduce antimicrobial resistance (AMR). Risk stratification of patients allows reductions to be made safely. To identify risk factors for hospital admission following UTI, to inform targeted antibiotic stewardship. Retrospective cohort study of East London primary care patients. Hospital admission outcomes following primary care consultation for UTI were analysed using linked data from primary care, secondary care, and microbiology, from 1 April 2012 to 31 March 2017. The outcomes analysed were urinary infection-related hospital admission (UHA) and all-cause hospital admission (AHA) within 30 days of UTI in primary care. Odds ratios between specific variables (demographic characteristics, prior antibiotic exposure, and comorbidities) and the outcomes were predicted using generalised estimating equations, and fitted to a final multivariable model including all variables with a P-value <0.1 on univariable analysis. Of the 169 524 episodes of UTI, UHA occurred in 1336 cases (0.8%, 95% confidence interval [CI] = 0.7 to 0.8) and AHA in 6516 cases (3.8%, 95% CI = 3.8 to 3.9). On multivariable analysis, increased odds of UHA were seen in patients aged 55-74 years (adjusted odds ratio [AOR] 1.49) and ≥75 years (AOR 3.24), relative to adults aged 16-34 years. Increased odds of UHA were also associated with chronic kidney disease (CKD; AOR 1.55), urinary catheters (AOR 2.01), prior antibiotics (AOR 1.38 for ≥3 courses), recurrent UTI (AOR 1.33), faecal incontinence (FI; AOR 1.47), and diabetes mellitus (DM; AOR 1.37). Urinary infection-related hospital admission after primary care consultation for community-onset lower UTI was rare; however, increased odds for UHA were observed for some patient groups. Efforts to reduce antibiotic prescribing for suspected UTI should focus on patients aged <55 years without risk factors for complicated UTI, recurrent UTI, DM, or FI.

International trends have shifted to creating large general practices. There is an assumption that interdisciplinary teams will increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate for some potential challenges of practice expansion, including continuity of care. To review available literature and examine how micro-teams are described, and identify opportunities and limitations for patients and practice staff. This was an international systematic review of studies published in English. Databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus) and grey literature were searched. Studies were included if they provided evidence about implementation of primary care micro-teams. Framework analysis was used to synthesise identified literature. The research team included a public contributor co-applicant. The authors conducted stakeholder discussions with those with and without experience of micro-team implementation. Of the 462 studies identified, 24 documents met the inclusion criteria. Most included empirical data from healthcare professionals, describing micro-team implementation. Results included characteristics of the literature; micro-team description; range of ways micro-teams have been implemented; reported outcomes; and experiences of patients and staff. The organisation of primary care has potential impact on the nature and quality of patient care, safety, and outcomes. This review contributes to current debate about care delivery and how this can impact on the experiences and outcomes of patients and staff. This analysis identifies several key opportunities and challenges for future research, policy, and practice.

Vulval lichen sclerosus (VLS) is a chronic inflammatory skin condition. Prevalence remains unclear as it is likely underreported and underdiagnosed. It affected one in 70 women presenting to a general gynaecology clinic.1 It can have a significant impact on quality of life, affecting sexual function and restricting other activities of daily living such as toileting, sitting, exercising, and socialising. Women may experience a loss of sense of self.2 If untreated, VLS is a progressive disease, with potential to lead to distressing anatomical changes and malignancy. Early diagnosis and treatment are key to reducing the impact on women’s lives, and preventing long-term sequelae. General practice has a key role in enabling timely diagnosis and treatment, but women often report long delays to diagnosis despite repeatedly seeking help. Missed opportunities for diagnosis and the resulting distress were a major theme in the current authors’ recent study.2 VLS may be commonly misdiagnosed as candidiasis or genitourinary symptoms of menopause (GSM). With rising awareness of GSM and the shift to teleconsultations, delayed diagnosis by primary care practitioners is an increasing risk. While not mentioned in detail in the recently published Women’s Health Strategy,3 vulval disease is an important component of a number of its priority areas and must not be forgotten. This article describes practical information for GPs. The words woman/women have been used, but the …&#13;\n&#13;\n

It's been, so far, another tough winter on the NHS frontline. In recent weeks, a perfect storm of flu, COVID-19, strep A, and a litany of respiratory bugs has led to exceptional demand in general practice for urgent on-the-day appointments. Many GP surgeries are taking action to limit same-day appointments after being left trying to cope with unsafe numbers of patients on the duty list. 1 What are safe workload limits in general practice, and how can these limits be implemented in practice? Quantifying safe working in general practice is difficult as workload is dependent on practice list size, patient population, workforce, and staffing factors. 2 Despite this complexity, I was surprised at the paucity of research around safe levels of working in general practice. A 2015 questionnaire of 25 European countries found that those nations with more than 25 direct patient consultations per day found general practice unsustainable, with more problems in GP retention and recruitment. 3 As a guide, the British Medical Association (BMA) suggests that 25 direct patient contacts a day (at 15 minute appointment times) is safe, but also suggests that patient complexity should be taken in to account in safe working. While a GP might be able to safely complete a maximum of 35 low-complexity routine appointments, 15 complex appointments relating to long- term or mental health issues could be viewed as unsafe. 4 The number of patient contacts is somewhat easier to predict and manage in a pre-bookable appointment system. But what about on-the-day demand, or the duty doctor system for urgent appointments? Of 455 GPs who responded to a recent GPonline poll, 60% said they delivered more than the 25-contact limit every day. A further 17% said they exceed the limit more than once a week. 5 Much of this is driven by same-day demand. The BMA 'strongly recommends' moving away from a duty doctor system with uncapped demand as this can lead to unsafe levels of patient contacts. But what happens when on-the-day duty lists are capped? Among regularly updated guidance on safe working practices (which all fulfil the requirements of the This article was first posted on BJGP Life on