EKU Podcast: Rational testing in primary care

Estimates have suggested that 25% of primary care laboratory tests might be ‘unnecessary’, with research demonstrating unwarranted variation and overuse of specific tests including thyroid function tests, liver function tests, prostate- specific antigen tests, and vitamin D tests. In this podcast Dr Thomas Round talks to Dr Jessica Watson, GP and Consultant Senior Lecturer at the University of Bristol with an interest in evidence based rational testing, about rational testing in primary care. They explore why testing is undertaken in medicine and general practice, when doctors should use blood tests, how to share information about tests with patients, manage patient queries and demand and when to retest. They discuss the increase in testing demand, the science behind testing and what the evidence shows us regarding over testing. In addition, they review recent research and guidance e.g. accessible results practical toolkits and the PITSTOP project. They also offer top tips for everyday practice and signpost to useful resources.RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.TranscriptReferences & Further Reading: Watson J, Burrell A, Duncan P, et al. Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive. British Journal of General Practice 2024; 74 (740): e133-e140. Buss L F, Spitzer D, Watson J C, et al. Can I have blood tests to check everything is alright? BMJ 2023; 382: e075728. Smellie W S A. Spurious hyperkalaemia. BMJ 2007; 334 :693. McCormack J P, Holmes D T. Your results may vary: the imprecision of medical measurements. BMJ 2020; 368: m149. University of Bristol. Accessible Results: Accessible Results – Enabling patients with diverse needs to access and understand their blood test results online. (Toolkit will be published in November 2026). Watson J. PITSTOP: Project 823 | Using Routine Primary Care Data and Co Production to Reduce Potentially Inappropriate Testing (PITSTOP): A Mixed Methods Study. NIHR School for Primary Care Research (SPCR). Learn evidence-based methods to make more accurate diagnosis. Testing Wisely O'Sullivan J W, Stevens S, Hobbs F D R, et al. Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests. BMJ 2018; 363: k4666.

In this podcast we interview Dr. Katherine Peterson, a GP partner and strategic clinical lead for learning disability, neurodivergence and mental health in North East and North Cumbria ICB. Patients with learning disability can have difficulties accessing primary care and have worse health outcomes than the general population. This podcast discusses some practical ways that practices can improve care for this cohort. 

In 2024 there were 3,043 new HIV diagnoses in the UK, this is a 4% decrease from 3,169 diagnoses in 2023; while in England, new HIV diagnoses decreased by 2% from 2,838 in 2023 to 2,773 in 2024.In this podcast Dr Thomas Round talks to Dr Shrey Mathur, an academic GP in East London and researcher at Queen Mary University of London with an interest in HIV early diagnosis, about HIV and the role of primary care. They reflect on what HIV is, its historical context and the changes in diagnosis, treatment and management and the need to move away from potential bias within specific populations/at risk groups for testing and ways to reduce the stigma. They discuss when to test in primary care including thresholds and managing positive results, transfer of care to specialist services and communication between the two, coding patient records accordingly around medications, the use of Post exposure prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) and long-acting injectables. They also offer top tips for everyday practice and signpost to useful resources. RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.References: People First Charter HIV Lens Liverpool HIV Drug Interactions Tool British HIV Association (BHIVA) NICE Clinical Knowledge Summary: HIV infection and AIDS NICE Clinical Knowledge Summary: HIV infection - treatment. Resources: RCGP eLearning course on Contraception RCGP eLearning course on Sexual health RCGP eLearning course on Sexual and reproductive needs of the LGBTQ+ community.

It is estimated that there are almost 3.5 million people living with cancer in the UK and on average someone is diagnosed with cancer at least every 75 seconds (UK). In this podcast Dr Thomas Round talks to Professor Willie Hamilton, a Professor of Primary Care Cancer Research about the updates to cancer detection in primary care. They reflect on why primary care is so important in this area, the changing epidemiology in cancer and cancer in younger people including the increase in colorectal cancer. They discuss the changes in cancer screening e.g. cervical cancer (introduction of home screening) and bowel cancer (age reduction and Faecal immunochemical test (FIT) thresholds), Positive Predictive Value (PPV), symptomatic presentations, difficult to diagnose cancers and atypical presentations. They also offer top tips for everyday practice and signpost to useful resources.RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete. References Best4: Screening for oesophageal health problems NHS Galleri Trail: Detecting cancer early Jess’s Rule: Three strikes and we rethink ERICA Study. Prof. Willie Hamilton Save T, Neal R D, Round T. A multi-cancer early detection (MCED) test: clinical update for GPs. British Journal of General Practice 2024; 74 (745): 380-382.  Wiering B, Mounce LTA, Price SJ, et al. The impact of morbidity burden on cancer diagnosis; a retrospective cohort study in England. Cancer Epidemiol. 2026 Feb 27;102:103027.  Further readingRCGP eLearning courses on: Behaviour change and cancer prevention Bloating and Other Abdominal Symptoms: Could it be Ovarian Cancer? Breast Cancer Screening - The Essentials Cancer detection in primary care Colorectal Cancer Early diagnosis of cancer in young adults Lung Cancer Pancreatic Cancer: Early Diagnosis in General Practice Primary cancer care toolkit Prostate Cancer: Early Diagnosis in General Practice Cancer care | One Day Essentials | REWIND (available until 26.05.26)

Respiratory disease, including infections, affects one in five people in England and is the third biggest cause of death, with around 68,000 annual deaths.In this podcast Dr Thomas Round talks to Professor Paul Little, a GP and Professor of Primary Care Research at the University of Southampton about respiratory tract infections. They provide a discussion on the common presentations to primary care including symptoms and their duration, natural history, assessment (triage), red flags, treatment including best practice for the use of antibiotics (NNT and NNH, TARGET toolkit), point of care testing (CRP), the use of nasal sprays, encouraging at risk groups to receive vaccinations, continuation of hand washing, and the impact of stress on illness. They also offer top tips for everyday practice.RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.Further reading: RCGP Essential Knowledge Update Hot Topic: Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care RCGP TARGET antibiotics toolkit hub Little P, Vennik J, Rumsby K, et al. Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: a randomised, controlled, open-label, parallel-group trial. Lancet Respir Med. 2024 Aug;12(8):619-632.  Little P, Stuart B, Andreou P, et al. Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor). BMJ Open. 2016 Apr 20;6(4): e009769.

Irritable Bowel Syndrome (IBS) affects approximately 1 in 20 people in the UK, equating to around 3.2 million individuals, though some estimates suggest up to 1 in 5 adults experience symptoms, with potentially even more not seeking medical help. It's a common digestive disorder, more prevalent in women, often starting in the 20s or 30s.In this podcast Dr Thomas Round speaks to Dr Kevin Barrett, a GP in Hertfordshire with a special interest in gastroenterology in primary care, about the prevalence, symptoms, diagnostic criteria, treatment and management of IBS and offers top tips for primary care practice!RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.For more information please see: RCGP eLearning course on Inflammatory Bowel Disease RCGP eLearning course on Holistic care for patients with inflammatory bowel disease RCGP eLearning course on the Diagnosis and management of coeliac disease and its immunological comorbidities RCGP Essential Knowledge Update module on the Management of irritable bowel syndrome RCGP Essential Knowledge Update module on the Management of ulcerative colitis and Crohn’s disease

Primary care consultations can be challenging for a number of reasons. In this podcast, Dr. Ed Pooley discusses the key skill of relationship building within general practice and how this can be achieved with a variety of consultation techniques. He addresses issues of raised emotions within consultations, how to recover a consultation which is going badly, and the key skill of housekeeping as it refers to GP consultations. The podcast also discusses how consultation skills might change over the course of a career and the importance of recognising issues which can or can’t be resolved within general practice. RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.

Eczema, also known as atopic dermatitis, is estimated to affect 1 in 5 children and 1 in 10 adults in the UK, making it one of the most prevalent skin conditions experienced across all age groups. It is the leading cause of skin-related disability in the UK and there has been an increased prevalence of eczema in the last 10 years.In this podcast Dr Thomas Round talks to Dr Khyati Bakhai, a GP in North East London about eczema. They discuss the definition of eczema, as well as the presentation, symptoms, risk factors including family history and other allergies, discussions during consultation, treatments such as emollients, protopics and steroid creams, assessing for infection, referral to secondary care when needed, management of flare ups and shared decision making with patients for ongoing management.RCGP Podcast Feedback Your feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.For more information please see: RCGP eLearning course on Atopic Eczema RCGP eLearning Hub on Atopic Dermatitis RCGP Essential Knowledge Update module on Atopic eczema in under 12s & Venous eczema and chronic venous disease RCGP podcast on Dermatology Podcast: Skin of Colour.

In 2020 the NHS became the world’s first health system to commit to reaching Net Zero and take action to reduce the future impacts of climate change. Take a walk through London to the Story Garden with Dr Toni Hazell, Deputy Medical Director for eLearning and Dr Liliana Risi, provost and past chair of the RCGP North East London Faculty, a past NHS GP in Tower Hamlets and Associate of Greener Practice to learn more about the topic of Net Zero. In this podcast we discuss climate health equity, the environmental benefits of social prescribing and preventing illness plant-based diet, all of which are covered within our three recently released eLearning courses, as well as Greener Practice, Singing for breathing and Clean air champions.Correction: Green social prescribing can save the NHS more than £600 million per year.RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete.RCGP Net Zero HubRCGP eLearning modules on: Climate health equity The environmental benefits of social prescribing Preventing illness: plant-based diet The Story Garden

Metabolic dysfunction-associated steatotic liver disease (MASLD), also known as Non-alcoholic fatty liver disease (NAFLD), is estimated to affect up to 1 in 5 people in the UK. Rates are increasing with rising levels of obesity. Although most cases of MASLD are linked to excess weight, you can develop the disease if you have a healthy weight.In this podcast, Dr Thomas Round talks to Dr Helen Jarvis, a GP and Clinical lecturer and researcher at Newcastle University with an interest in liver disease about fatty liver disease in primary care. RCGP Podcast FeedbackYour feedback plays a crucial role in helping us improve the CPD products and services we offer. We would be grateful if you could please complete our short RCGP Podcast Survey, which will take no more than 5 minutes to complete. RCGP. EKU Module on Diagnosis and management of non-alcoholic fatty liver disease. May 2024. RCGP. Liver Toolkit. June 2025 BSG. BSG Guidelines on the management of abnormal liver blood tests. December 2021. NICE. NG49. Non-alcoholic fatty liver disease (NAFLD): assessment and management. July 2016 (last reviewed October 2024).