Sam Finnikin

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...

Great episode. Loved the discussion and your insights Jess.

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' not real, finds major trial coordinated by departments Primary Care Clinical Trials Unit A department Clinical Trials Unit coordinated trial has found most penicillin 'allergies' are not real. Safely removing these incorrect labels can lead to better patient treatment and is a vital step ...

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

Always want to catch up Alf! Just prepping the manuscript for submission but will give you a sneak preview.

My first Bluesky publication announcement! Just a protocol but I think it’s an interesting one. We’ve done the work now and the findings are fascinating…!

NHS England » Decision support tool: making a decision about cataracts NHS England » Decision support tool: making a decision about cataracts

How about adding…
All patients referred for cataracts should get chance to use the NHSE decision support tool at the point of referral:

www.england.nhs.uk/publication/...

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

We analysed almost 1,000 social media posts about 5 popular medical tests. Most were utterly misleading 87% of posts mentioned the benefits of the tests, while only 15% mentioned potential harms.

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-...

Episode 196: How to approach safety netting in general practice In this episode, we talk to Dr Pete Edwards about effective safety netting practices.

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-...

12. Sensible prescribing in older people with Jonathan and Lucy; Statins Podcast Episode · Talking Meds - A PrescQIPP podcast · 21/02/2025 · 19m

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 …

Statins, risk, and personalised care Sam Finnikin and colleagues argue that guidelines should focus less on population level risk thresholds and more on shared decision making conversations based on individualised risk and patient prefer...

Perhaps it would help for clinical prediction model outputs to avoid a false sense of precision implied when quoting results to 1 d.p.?
We discussed the use of risk estimates in CVD prevention in more detail here:
www.bmj.com/content/384/...

Interesting perspective - thanks for sharing.
I agree, it would be useful to have an idea of uncertainties around risk estimates but this would be tricky for (most) clinicians and patients to incorporate into decision making. More training on risk communication and SDM would help

Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches Clinical prediction models estimate an individual’s risk (probability) of a health related outcome to help guide patient counselling and clinical decision making. Most models provide a single point es...

**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/...

Mother with child sitting on her knee with doctor writing notes in the background.

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?

🧵

Healthcare is so much easier if you don’t think about it too much?
For ever complex problem there’s a simple solution…..

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 see your point. But it could be argued that acute knee injuries should be triaged and managed in secondary care. If we have access to MRI then this disincentivises ortho providing this service?

More scans, more problems—let’s fund prevention instead Mathew discusses GP access to magnetic resonance imaging (MRI).1 Multiple studies have been published in which patients without symptoms underwent MRI of the knee and were found to have abnormalities...

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

Appropriate management of heart failure in older people with frailty Guideline directed medical therapy for heart failure for older people with frailty may do more harm than good, say Henry Woodford and colleagues The management of heart failure is evolving. Recent c...

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*

Interesting episode as always. I definitely would have used that mouthwash as hand wash.
But more importantly; guidelines…definitely a double edged sword.

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.