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Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England. In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed. Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105). Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes. Public Health England.

Colorectal cancer (CRC) is a significant contributor to cancer-related burden, ranking second in cancer mortality in France. Despite the proven survival benefits of systematic CRC screening, uptake remains suboptimal, particularly among people with limited health literacy (HL) and lower socioeconomic position. This study aimed to assess the acceptability of an e-learning training programme on HL and CRC screening among general practitioners (GPs) in deprived areas while also exploring strategies for its promotion and scale-up. A qualitative study nested within the DECODE cluster-randomised controlled trial (NCT04631692) across four French regions was conducted. Semi-structured interviews (phone or online) were carried out to capture opinions, experiences, and recommendations of GPs in the intervention arm. Thematic analysis, employing manual and NVivo coding, was performed. The majority of 22 GPs (16/22) found the training acceptable, informative, tailored to their knowledge needs and offering great flexibility of use. The module on HL garnered more interest than the one on CRC screening, as it addressed a relatively new area for many GPs. It facilitated reflection on patient communication techniques and identified areas for improvement in physician-patient interaction. A perceived gap in the training was the insufficient interactivity in both didactic and virtual group sessions. The findings of this study show high acceptability of the e-learning training by participants, indicating a potential for implementation, if kept concise, self-paced, asynchronous, and with a stronger focus on HL. The training helped GPs reflect on their practices, enhance HL knowledge, and improve patient communication strategies, leading some to adopt new techniques in daily interactions with low HL patients, beyond just screening.

Background Continuing medical education (CME) is vital for patient care, society, and general practitioners’ (GPs) wellbeing. Despite its benefits, some GPs attend CME infrequently. While GPs’ preferences for CME are well documented, it is unclear if these preferences are shared by infrequent users. Exploring infrequent CME users’ preferences and educational needs is essential to engage them effectively. Aims of the study: To explore infrequent users’ preferences for CME formats and their attitudes towards mandatory CME compared to their CME attending GP colleagues. Methods A cross-sectional questionnaire study was conducted among all 3,257 GPs in Denmark. Descriptive statistics and logistic regression analyses were used. Results Responders were categorized into four CME user types: frequent (42%), partial (44%), infrequent (14%), and “do not know” (< 1%). All responders highly valued teachers and course leaders with insight into general practice. Overall, interactive learning activities and formats directly applicable to clinical practice were preferred, while online education, self-study, fact-based lectures, and sponsored meetings ranked lower. Infrequent users were more positive than frequent users towards reading on their own and fact-based lectures without participant involvement and short travel time. They were less positive about time-consuming learning such as week-long courses and courses abroad. Among infrequent users, 72% were principally opposed to mandatory CME setups, whereas a much smaller proportion opposed the current extent of mandatory CME in Denmark. This suggests a difference between practical acceptance and principled opposition. Despite infrequent users’ reluctance towards participant involvement, they were open to small group learning and in-practice formats. Conclusion Teachers and course leaders with profound insight in general practice and patient-focused content seem to be an unquestionable requirement for successful CME. Infrequent users’ reluctance towards participant involvement, but openness to small group learning and in-practice formats should be used strategically. Offering a variety of accessible, smaller-scale courses supports autonomy and diversity. Mandatory CME is not seen exclusively negatively and can be accepted if perceived relevant or as a valuable break or educational guarantee. However, it must be balanced with voluntary options to avoid causing demotivation.

A previous article presented stories of registrars' journeys through early general practice training. This paper aims to explore in detail two registrars' stories using the lenses of transformative learning theory and threshold concept theory to seek fresh insights into becoming a general practitioner. This study explored the experience of 12 registrars undertaking their first general practice term using a qualitative narrative enquiry approach. Two stories are examined in more detail to see if they resonate with the transformative learning and threshold concept theories. Both theories appear to have resonance with the experiences, as described by the two registrars. The transformative experience of early general practice training can be usefully described by transformative learning theory as a holistic change of 'meaning perspective', and also as learning key threshold concepts. This might help inform future registrars' learning and supervisors' teaching.

The transition from trainee to professional marks a key milestone in a family doctor's career, bringing both emotional and mental challenges. This critical period of specialisation shapes how young doctors adapt and influences their future career choices. We explored trainees' experiences during their first year of advanced medical training in family medicine/general practice, including barriers and facilitators. Using qualitative methodology, we conducted ten focus group interviews with 111 trainees. These group interviews were held as part of small-group sessions integrated into a self-guided reflection course. All interviews were held between February 2021 and March 2021, conducted online via MS Teams, recorded, and transcribed verbatim for analysis. Our analysis uncovered two adaptational processes during this transition period: personal adaptation and professional socialisation. We interpreted this as a complex balancing act, with impact on mental health aspects such as energy, exhaustion, and self-confidence. Multiple elements at different levels influenced these processes, including the workplace (e.g. interactions with colleagues and patients), the educational program (e.g. assignments, courses), and societal expectations (e.g. role expectations, support). The findings highlight the importance of understanding both personal adaptation and professional socialisation to support trainees effectively during their transition into practice. Future studies should validate these findings and explore their evolution over time, particularly in relation to adaptation and career choices.

The COVID-19 pandemic has rapidly changed general practice in the UK. Research is required to understand how General Practitioners (GPs) and GP trainees adjusted to these changes, so that beneficial changes might be sustained, and Primary Health Care (PHC) can be prepared for future challenges. This study explored the experiences and perspectives of GP and GP trainees during the pandemic. Remote, semi-structured interviews (n = 21) were conducted with GPs (n = 11) and GP trainees (n = 10), recruited from across the UK using convenience and purposive sampling. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed with an inductive thematic approach. Five overarching themes were identified: (1) 'Thrown in at the deep end'; (2) Telemedicine: 'it needs to be a happy balance'; (3) Delayed referrals and 'holding' patients; (4) The Covid Cohort-training in Covid; (5) Suggestions and lessons for the future of general practice'. GPs reported a turbulent and uncertain time of major changes to PHC. They described the benefits of technology in general medicine, particularly telemedicine, when used in a balanced manner, highlighting the need for accompanying teaching and guidelines, and the importance of patient preferences. Key tools to help GPs manage patients with delayed referrals to Secondary Care were also identified. Several key changes to general practice occurred as a result of the COVID-19 pandemic, including a rapid uptake of telemedicine. The pandemic exposed the strengths and limitations of normal general practice and highlighted the importance of workplace camaraderie. These findings contribute to the evidence base used to adapt PHC infrastructures as we emerge from the pandemic.

Eating disorders (EDs) are a significant public health concern, yet men remain underrepresented in research and care, partly due to stigmatization. This stigmatization contributes to reduced help-seeking and recognition of ED symptoms in men. To address this, targeted interventions for healthcare professionals are needed. The iSMEsH intervention aims to sensitize general practitioners (GPs) in Germany to EDs in men, impart relevant knowledge and skills, and counter the perception of EDs as \"women's diseases\". We will evaluate the iSMEsH intervention regarding its effects on biased attitudes, knowledge, and self-efficacy among GPs. A sequential explanatory mixed-methods design (QUAN → qual) will be applied in three steps: (1) pre-implementation focus groups and a panel discussion with individuals with lived ED experience and GPs to design the intervention, (2) conduction of a randomized, wait-list controlled trial of the online training trial with GPs and medical students, and (3) post-implementation qualitative interviews with GPs. Quantitative data (step 2) will be analyzed using mixed-measures ANOVAs and contrast analyses (per-protocol) as well as corresponding 2 × 3 linear mixed models with fixed and random effects (intention-to-treat). Qualitative data from step 3 will be analyzed using thematic analysis as outlined by Braun and Clarke (2006). Ethical approval was granted by the Ruhr-University Bochum Ethics Committee (AZ 2023-1106). Participants will provide written or digital informed consent. The intervention seeks to reduce stigma against men with EDs in primary care by improving GPs' and medical students' knowledge, attitudes, and self-efficacy. Strengths include the comprehensive mixed-methods approach and involvement of people with lived experience. Limitations are reliance on self-report and short-/intermediate-term outcomes. If effective, iSMEsH may offer a foundation for future stigma-reduction strategies in healthcare.

Background Pursuing excellence in healthcare delivery systems is an ongoing process. In this process, continuing medical education (CME) is essential for medical professionals to maintain high standards of patient care. In China, where the healthcare sector is undergoing considerable reforms and faces challenges owing to socioeconomic development and demographic shifts, an effective CME system is vital for general practitioners (GPs). Methods A cross-sectional survey of CME programs was conducted between 2016 and 2023. The external characteristics of the programs were systematically gathered and statistically analyzed. The programs were subsequently subjected to a competency-based assessment by using the six core competencies outlined by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education as a framework. Furthermore, keywords were extracted for the CME program names based on the International Classification of Primary Care. Visual analysis was performed via VOSviewer software, facilitating a content-based evaluation of the programs. Results A total of 6,607 items were obtained. A total of 3,815 CME programs were subjected to statistical analysis, and 2,895 CME programs were comprehensively evaluated for content and capability. A diverse range of CME providers were identified, with hospitals and publishing/education companies being the primary providers. Since 2019, a significant increase in online CME offerings has been noted. However, the regional distribution of the CME programs was uneven, with Shanghai, Zhejiang, and Beijing leading but western China lagging. Furthermore, most programs focused on patient care and medical knowledge in competency-based CME evaluations, with less emphasis on interpersonal and communication skills. Content-based CME evaluations revealed that the teaching focus is the diagnosis, treatment, and primary care management of elderly patients and chronic diseases such as diabetes and hypertension. Conclusions Our findings underscore the essential role of CME in equipping GPs with the competencies required to navigate the evolving landscape of medical knowledge and practice, suggesting a more systematic, relevant, and individualized approach to training GPs. Therefore, there is an opportunity to increase the quality of primary care and contribute to the Healthy China 2030 Plan.

Context The COVID-19 pandemic led to an increase in numbers of patients dying at home in the UK, meaning that general practitioners (GPs) were exposed to more patient death than would be pre-COVID. This project aimed to gain insight into GP trainees’ experiences of patient death between March and July 2020. This insight can inform support for GPs, leading to improved wellbeing, workforce retention and ultimately, better patient-centred care. Methods Interpretative Phenomenological Analysis (IPA) of semi-structured interviews was used to explore GP trainees’ experiences of patient death in one region of England. Results Seven trainees, two male and five female, participated. They were working in both rural and urban community settings and were at different stages of GP training. Group experiential themes related to heightened emotional responses to patient death, managing uncertainty and the increased salience of relationships. Most appreciated positive teamworking and solidarity, though some had felt isolated within their surgery and wider community. There were some unforeseen positive experiences of individual and organisational healthcare changes, including a perceived new appreciation for the NHS workforce equality, diversity and inclusion (EDI) by actions to identify and reduce occupational hazards to at-risk healthcare staff. There were potential effects on career choice with participants feeling that changes during COVID-19 offered new flexibility in working arrangements and opportunity to sub-specialise within GP. Conclusion More support to help navigate the amplified emotional responses to managing dying and death in the community is needed. Some experiences, particularly around managing uncertainty, can cause moral injury if not managed in a safe and supportive environment.