Primary Care Knowledge Boost Primary Care Knowledge Boost

Doctors Lisa and Sara talk to Dr Saadat Ahmed, ST5 in Geriatrics for a deep dive into Osteoporosis. We cover what it is, why it matters, what the risks factors are, who and how to assess for it, and what to do with results from FRAX and DXA scans. After a discussion on lifestyle options to help improve bone health, we ask advice on counselling patients around the pros and cons of taking Bisphosphonates including his advice on talking about the rarer side effects.
We talk through a case and ask advice on how to reassess bone health after these initial conversations, and medications might have been started, including when to consider drug holidays.
 
Lots of excellent CPD here we feel. Enjoy and please share with any interested clinicians/trainees as you see fit.
 
Useful resources: 

Osteoporosis - Prevention of Fragility Fractures NICE CKS Guidelines (updated Apr 2023): https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/


FRAX Calculator UK (Link from National Osteoporosis Guideline Group UK: https://frax.shef.ac.uk/FRAX/tool.aspx?country=1


WHO Falls Management: https://www.who.int/news-room/fact-sheets/detail/falls


National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/full-guideline/section-4-intervention-thresholds-and-strategy
https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk


SIGN Scottish Osteoporosis Guidelines (discussion of evidence for links between PPIs and Osteoporosis on page 27): https://www.sign.ac.uk/media/1812/sign-142-osteoporosis-v3.pdf


Osteonecrosis of the Jaw relative risk discussed on page 37 of National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf


Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus, Journal of Bone and Mineral Research. Khan A et al 2015: https://pubmed.ncbi.nlm.nih.gov/25414052/


Flow Chart for Oral Bisphosphonates long term treatment and monitoring NOGG Guidelines: Page 35: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf


Rubin KH, Rothmann MJ, Holmberg T, et al. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporosis Int 2018; 29(3): 567-78. https://pubmed.ncbi.nlm.nih.gov/29218381/


Merlijn T, Swart KM, van Schoor NM, et al. The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial. J Bone Miner Res 2019; 34(11): 1993-2000. https://pubmed.ncbi.nlm.nih.gov/31220365/


Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporosis Int 2020; 31(2): 251-7. https://pubmed.ncbi.nlm.nih.gov/31838551/

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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
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This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is stil

Doctors Lisa and Sara talk to GPs Dr Joanna Bircher, Dr Lucy Spurrell and Dr Dario Rydel about their experiences in different roles in General practice; salaried, partner and locum. The aim of the episode is for GPs or GP trainees listening to get a flavour of their experiences and to understand the pros and cons of each of those roles in general practice, with a particular focus on the partnership model and the benefits of becoming a partner.
Useful resources: 

GPOnline Talking General Practice Podcast, Dr Katie Bramall-Stainer on the GP contract and the fight for a better deal: https://www.gponline.com/podcast-dr-katie-bramall-stainer-gp-contract-fight-better-deal/article/1865234


The Leadership Hike Book:: https://www.amazon.co.uk/Leadership-Hike-Shaping-Primary-Together/dp/0367236982


Medics Money podcast: https://www.medicsmoney.co.uk/medical-accounting-blog/?catname=podcasts


GP Excellence: https://gmpcb.org.uk/general-practice/gp-excellence/

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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Tim Dalton, a GP in Wigan, and Chair of the Greater Manchester GP Provider Board. The focus of today’s episode is all about how general practice is funded. They cover how it is different from other NHS settings, the sources of income in general practice and the flow of money through the system, DES’, LES’ and QOF, the place of PCNs and Federations, as well as talking about different types of GP contracts and what these mean. To note: this was recorded in March 2024, just before the new contract details were released and so doesn't contain the specifics of the new contract.
Useful resources: 

The Kings Fund: GP funding and contract explained: https://www.kingsfund.org.uk/publications/gp-funding-and-contracts-explained


NHS England: GP Contract: https://www.england.nhs.uk/long-read/gp-contract/

GPOnline Talking General Practice Podcast, Dr Katie Bramall-Stainer on the GP contract and the fight for a better deal: https://www.gponline.com/podcast-dr-katie-bramall-stainer-gp-contract-fight-better-deal/article/1865234
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined this week by Satty Boyes (Senior programme manager) and  Lorna Laflin (Previous Practice Manager who works with the GP Excellence team). They discuss a new platform in Greater Manchester for the non-clinical workforce within General Practice, which allows staff to explore progression pathways,  track their professional progress, and access learning opportunities all in one place. 
Some quotes from those who have accessed the platform already: 
“I think this is an absolutely wonderful tool and wish that there had been something like this available when I first started my career with the NHS. Easy to use and lots of really useful information. I would be really inclined to push some of my administration staff to enrol for the passport to develop their skill-set. A wonderful piece of work. Well done to the team for pulling this all together.” “Useful for everyone to understand that career progression pathways ARE available if they wish to progress. Very useful to see standardised Job Descriptions and training pathways all in one place.”
Useful resources: 

Greater Manchester Non-Clinical Workforce Programme: https://gmprimarycare.org.uk/primary-care-passport/non-clinical-workforce-programme/

___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Specialty Doctor Caitriona MacDermott about anticipatory prescribing for Palliative patients. An area where there has been much learning over the last several years, it is a good opportunity to get some teaching on why this is the case, the stages involved in recognition and addressing symptoms at the end of life, the need for regular reviews in terms of the potential for change and her advice on how she opens up conversations around future needs, death and symptom control. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf
NICE Guidelines related to caring for Adults at the End of Life: https://www.nice.org.uk/guidance/ng142
The Gosport Independent Panel Report: https://www.gosportpanel.independent.gov.uk/
RCGP End of life and palliative care toolkit: https://elearning.rcgp.org.uk/mod/book/tool/print/index.php?id=12529&chapterid=272
Compassion in Dying Information on Do Not Resuscitate Forms and CPR decisions for Patients: https://compassionindying.org.uk/how-we-can-help/do-not-resuscitate-dnr-forms-and-cpr-decisions/
British Journal of General Practice: The Liverpool Care Pathway for the dying, what went wrong? Knights D, Wood D, Barclay S (2013: 63): https://bjgp.org/content/63/615/509/tab-article-info
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is the third episode in our MSK mini-series. Doctors Lisa and Sara speak to Tom Smith and Charlotte Barker again, who are First Contact Practitioners in Wigan. The focus of this chat is shoulder pain - using a hypothetical case to discuss important history points, red flags, useful examination tips, differential diagnoses and further assessment options.
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 

Escape Pain: https://escape-pain.org/


Be Well Wigan: https://www.wigan.gov.uk/BeWell/index.aspx


Versus Arthritis: https://versusarthritis.org/


Age UK: https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/arthritis/


NICE CKS Guidelines for Knee Pain: https://cks.nice.org.uk/topics/knee-pain-assessment/


NICE Osteoarthritis Guideline (NG226): https://www.nice.org.uk/guidance/ng226


NHS Decision Making Tool for Knee Osteoarthritis: https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-knee-osteoarthritis/ 


Patient Exercise Options: https://www.nhs.uk/conditions/nhs-fitness-studio/

___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.