The British journal of general practice : the journal of the Royal College of General Practitioners最新文献

{"title":"Online triage and cancer diagnostic activity in general practice: a cross-sectional study.","authors":"Armina Paule, Helen Atherton, Joanne Parsons, Louise Hiller, Gary Abel","doi":"10.3399/BJGP.2025.0735","DOIUrl":"10.3399/BJGP.2025.0735","url":null,"abstract":"<p><strong>Background: </strong>Patient-facing online triage tools potentially offer GPs a way to recognise cancer-related symptoms and features to facilitate appropriate suspected cancer referrals. Little is known about their impact on cancer diagnostic process and outcomes.</p><p><strong>Aim: </strong>To describe patterns of cancer outcome and process indicators associated with the use of online triage tools in primary care.</p><p><strong>Design and setting: </strong>This cross-sectional study examined the association between publicly reported practice-level data on 3053 English general practices. An online triage tool was used that linked to practice-level data and 31 233 594 triage forms completed using an online triage tool in 2022-2023.</p><p><strong>Method: </strong>A cross-sectional analysis (mixed-effects regression) was conducted to evaluate the association between the annual rate of eConsult forms received (weighted to practice registrations) and various cancer diagnosis process and outcome measures.</p><p><strong>Results: </strong>Increased use of online triage forms was associated with higher rates of urgent suspected cancer (USC) referrals and investigations; for example, there was a 7.75% difference in colonoscopy rate (95% confidence interval [CI] = 3.83% to 8.98%) across the 90% mid-range of practices. Despite this, there was no evidence of an association with USC referrals resulting in diagnosis or emergency presentations.</p><p><strong>Conclusion: </strong>Greater use of online triage forms is associated with more investigations and referrals for suspected cancer, but not associated with better diagnostic outcomes. This may indicate that any additional referrals are of lower quality and overall there is an increase in inappropriate use of USC referrals. Research is needed to understand how this impacts investigations and referrals for individual patients.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding chronic pelvic pain in women survivors of sexual violence: a qualitative study.","authors":"Catherine Mccarter, Amanda C de C Williams","doi":"10.3399/BJGP.2026.0057","DOIUrl":"https://doi.org/10.3399/BJGP.2026.0057","url":null,"abstract":"<p><strong>Background: </strong>Chronic pelvic pain (CPP) affects an estimated 14.8% of UK women. Survivors of sexual violence are more likely to experience CPP, but the relationship is complex and underexplored. Shame and stigma from both experiences may interact and influence help-seeking.</p><p><strong>Aims: </strong>To broaden understanding of how women survivors of sexual violence make personal meaning of CPP, and to consider clinical implications of findings.</p><p><strong>Design & setting: </strong>A qualitative study of UK community-recruited women who have survived sexual violence and who experience chronic pelvic pain (CPP).</p><p><strong>Method: </strong>Ten participants were recruited via social media and engaged in individual, semi-structured online interviews about their experiences and understandings of sexual violence and CPP. Interviews were transcribed verbatim and analysed using reflexive Thematic Analysis.</p><p><strong>Results: </strong>Three main themes were developed: (1) Healthcare professionals' attempts to silence women, who felt ignored, disbelieved or dismissed; (2) Treating the whole woman, describing the need for integrated, biopsychosocial approaches; and (3) A woman's place is in the resistance, highlighting women's active efforts to reclaim their narratives and pursue care. Shame was compounded across experiences, and women expressed frustration with fragmented care and assumptions about the psychological origins of pain.</p><p><strong>Conclusions: </strong>These results give insights into the complex meanings women survivors of sexual violence hold about their CPP, and how healthcare systems could better support them to explore and respond to those meanings. The aim should be compassionate care that recognises the complex biopsychosocial impact of sexual violence and CPP, while keeping women in control of their own care.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and prognostic outcomes for men with prostate cancer detected through opportunistic, asymptomatic PSA testing or symptomatic presentation to primary care: The PC3 cohort study.","authors":"Samuel Merriel, Peter Nickol, Gary A Abel, William Hamilton","doi":"10.3399/BJGP.2026.0007","DOIUrl":"https://doi.org/10.3399/BJGP.2026.0007","url":null,"abstract":"<p><p>Background Primary care is the main route to diagnosis for patients with prostate cancer, either following asymptomatic Prostate Specific Antigen (PSA) testing or investigating prostate-related symptoms. Whilst previous primary care studies suggest an association between symptoms and prostate cancer diagnosis, it remains unknown whether outcomes differ based on the presence or absence of symptoms. Aim To compare prostate cancer stage, grade, and mortality amongst symptomatic patients presenting to primary care with asymptomatic patients. Design and setting Retrospective cohort study using Clinical Practice Research Datalink (CPRD) Aurum. Included adult males aged 50 years and above with first presentation to primary care for coded lower urinary tract symptoms (LUTS), haematuria, or erectile dysfunction between 01/01/2011 and 31/12/2016 with up to two asymptomatic males matched by age, ethnicity, and GP practice. Method Main outcomes: Clinically significant prostate cancer (Gleason Grade Group ≥ 3); Early-stage prostate cancer; Cambridge Prognostic Group; prostate cancer mortality; all-cause mortality. Mixed effect logistic regression modelling was performed. Results 722,597 males were included (262,178 [36.3%] had coded symptoms). Mean age was 64.4 years (SD 9.76). 90.68% identified as White ethnicity. 12,297 new prostate cancer diagnoses within 24 months of index consultation (8,101 [65.88%] in symptomatic group). Clinically significant prostate cancer (Adjusted OR 1.14 95% CI 1.07, 1.23) was more likely in the symptomatic group. No difference was found in stage at diagnosis (aOR 1.02 95% CI 0.95,1.09). Conclusion Investigating symptomatic patients in primary care is more likely to detect clinically significant prostate cancer with no difference in stage at diagnosis.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Primary Care Clinicians use Advice and Guidance: A qualitative study.","authors":"Alice Faux-Nightingale, Rosie Harrison, Claire Burton, Ram Bajpai, Lorna Clarson, Tina Hadley-Barrows, John Haines, Toby Helliwell, Samantha Hider, Clare Jinks, Kelvin Jordan, Natalie Knight, Christian D Mallen, Kayleigh J Mason, Victoria K Welsh","doi":"10.3399/BJGP.2026.0217","DOIUrl":"https://doi.org/10.3399/BJGP.2026.0217","url":null,"abstract":"<p><p>Background Where available, Advice and Guidance (A&G) can enable primary care clinicians to seek specialist input, supporting decision making and avoiding unnecessary referrals. The use of A&G has significantly expanded, accelerated by COVID19 and contractual changes. While A&G is intended to streamline elective care, concerns persist regarding workload shift, variable responsiveness, and system usability. Despite growing policy emphasis, little is known about why clinicians choose to use A&G. Aim Explore the current use of A&G within primary care, focusing on decision making processes which underpin PCCs' (primary care clinicians') decision to use A&G. Design and Setting Qualitative study set in English Primary Care Method Twenty semi structured video interviews were conducted with primary care clinicians purposively sampled for maximum variation. Data were analysed using reflexive thematic analysis within an interpretive description framework, with themes developed collaboratively and refined through discussion with researchers and PPIE contributors. Ethical approval was obtained (REC 333799). Results Four overarching themes encapsulate clinicians' decisions to use A&G: clinical presentation (acuity and complexity), navigating healthcare pathways, previous experiences of A&G, and using A&G to validate clinical decision making. Barriers included delayed responses and uncertainty about inequitable workload distribution. These factors shape how effectively A&G could be integrated into routine practice. Conclusion Primary care clinicians use A&G to support patient care and aid decision-making, but its effectiveness depends on timely, clinically helpful responses. Ensuring responses remain appropriate to primary care remit and capacity will be essential if A&G becomes the main route into elective care.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Talking about online activity and mental health with young people in primary care: A qualitative interview study.","authors":"Charlotte Archer, Myles-Jay Linton, David Kessler, Nicola Wiles, Lucy Biddle","doi":"10.3399/BJGP.2026.0076","DOIUrl":"https://doi.org/10.3399/BJGP.2026.0076","url":null,"abstract":"<p><strong>Background: </strong>Young people - aged 16-24 - are high users of digital technology. Online activity can be both beneficial for mental health and harmful. Appointments in general practice (GP) or primary care talking therapy provide opportunities to discuss online activity and its impact on mental health with young people. Such conversations could have preventive value by increasing awareness of problematic behaviours, identifying risk and suggest safer use strategies. However, little is known about whether such conversations are currently delivered in primary care.</p><p><strong>Aim: </strong>To explore practitioners views on discussing online activity and its role in the mental health of young people in primary care.</p><p><strong>Design and setting: </strong>Qualitative study with practitioners in GP and Talking Therapy Method: Semi-structured interviews with 24 practitioners, analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Practitioners recognise helpful and harmful aspects to online activity, but there is variation in whether practitioners currently ask about online activity and whether they consider conversations appropriate for primary care. Several factors may shape confidence and decision making: practitioners own understanding of the online world; unable to change the impact on mental health or signpost to services; limitations in time, confidence or topic awareness. Practitioners identified a need for guidance and training to inform conversations about online activity.</p><p><strong>Conclusion: </strong>There is variation in whether conversations about online activity with young people are happening in primary care. The development of best-practice resources is required to ensure conversations are acceptable to young people and effective at changing problematic online activity to improve mental health.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GP roles in emergency ambulance services in the United Kingdom: a qualitative realist study.","authors":"Alex Burrell, Matthew Booker","doi":"10.3399/BJGP.2026.0105","DOIUrl":"https://doi.org/10.3399/BJGP.2026.0105","url":null,"abstract":"<p><p>Background Demand on emergency healthcare services is increasing. Utilising GPs in emergency ambulance services (EAS) may be effective in reducing avoidable conveyances to emergency departments and releasing emergency ambulances for higher-acuity cases. There is limited evidence on models of GP EAS roles in the UK. Aims To describe current provision of GP EAS roles and to develop a provisional explanatory programme theory. Design & Setting Qualitative realist interview study with professionals with detailed knowledge and experience of GPs working in EAS. Method Interviews were conducted with 27 participants to explore the mechanisms by which GP EAS roles produce their intended outcomes in different contexts. Results The GP role is predominantly to undertake enhanced remote patient assessment following an initial algorithmic triage, aiming to provide the most appropriate level of care. Whilst optimising the clinical response to individual callers, this also serves a system-level function by protecting ambulance resources to support timely responses to high-acuity patients. The mechanism behind GP-triage was explored through existing middle-range theories around risk individualisation, the process of translating organisational risk appetite to individual patient contacts. This helps the ambulance service make 'braver' decisions; those involving non-conveyance, alternatives to conveyance, or lower-acuity responses. GPs do this effectively due to their seniority, broad clinical knowledge and experience, approach to risk and uncertainty, ability to practice outside guidelines, consultation and communication skills, and system awareness. Conclusion GPs in EAS serve both individual patients and the system by individualising organisational approaches to risk and resource management.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on the impact of an initial non-cancer diagnosis prior to a subsequent cancer diagnosis: a secondary qualitative analysis.","authors":"Mel Ramasawmy, Gary A Abel, Georgia Black, Claire Friedemann Smith, William Hamilton, Angela King, Richard Neal, Brian D Nicholson, Sarah Price, Luke Robles, Fiona M Walter, Bianca Wiering, Suzanne Scott","doi":"10.3399/BJGP.2025.0710","DOIUrl":"https://doi.org/10.3399/BJGP.2025.0710","url":null,"abstract":"<p><p>Background Timely diagnosis of cancer can be challenging as most present with non-specific symptoms in primary care. A third of those diagnosed with cancer report receiving a non-cancer diagnosis, before being referred for cancer investigations ('interim' diagnosis), presenting a potential missed diagnostic opportunity. Aim This study explored patients' experiences of receiving a non-cancer diagnosis prior to referral for investigation for suspected cancer. Design and Setting Secondary qualitative analysis of seven interview datasets collected in primary care in the UK since 2015. Method Patient journeys were summarised, charted and analysed using framework analysis. Patient Public Involvement and Engagement collaborators were involved throughout. Results 58 transcripts were included in which the patient presented to primary care with symptoms and received an interim non-cancer diagnosis. We identified eight common scenarios involving an initial non-cancer diagnosis followed by referral for suspected cancer. For example, individuals considered at low risk of cancer reported symptoms being linked to lifestyle factors, requiring multiple contacts over time before further investigation was considered. Patients queried interim diagnoses when they felt their symptoms and interpretations had been poorly understood, or they had been given inappropriate investigations or ineffective treatment. While patients recognised the difficulty of deciding when common symptoms required onward referral, they trusted clinicians who were responsive to their concerns, regardless of outcome. Conclusion Interim diagnoses arise as part of the normal diagnostic process in patients presenting with non-specific symptoms. Challenging these diagnoses in the face of new evidence could mitigate potential delays in diagnosis and improve patient outcomes.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correct, but not reassuring.","authors":"Koki Kato","doi":"10.3399/bjgp26X746193","DOIUrl":"10.3399/bjgp26X746193","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"363"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent care.","authors":"John Sharvill","doi":"10.3399/bjgp26X746325","DOIUrl":"10.3399/bjgp26X746325","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"348"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What partnership costs.","authors":"Sam Hilton","doi":"10.3399/bjgp26X746133","DOIUrl":"10.3399/bjgp26X746133","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"346-347"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}