Dr Julian Treadwell is a salaried GP and NIHR Doctoral Research Fellow at the Nuffield Department of Primary Care Health Sciences at Oxford University.
He’s just launched a new website, GP Evidence (gpevidence.org/), developed to make the scientific evidence underpinning guideline-recommended treatments easier to access and understand for practising GPs.
Dr Treadwell explains how he developed GP Evidence with the support of sessional GPs, how it might support shared decision-making, and ways it can make better use of CPD hours.
NASGP: What have you learned about GPs’ learning habits and needs while setting up GP Evidence? Did anything surprise you?
Dr Treadwell: The problem I’d first identified for myself in my own practice was that I was following guidelines and doing what I thought was good medicine, but that I felt I’d lost the ability to think about it. I wanted to know more about how to decide on how to treat individual patients, compare how effective different treatments are, and work out quickly how likely they were to reduce someone’s risk and how likely they were to get side effects. I realised I didn’t have information like absolute risk reduction and numbers needed to treat in my mind, nor was it easy to find that information.
Early on in this project, I did a survey of GPs online asking, exploring their understanding of evidence, for example knowledge of absolute risk reduction for common treatments. I found that other GPs were also feeling pretty low levels of confidence about this kind of knowledge. What I found out along the way was that, as GPs, we’re all in the same boat.
I had felt it myself and then, reflecting on everybody else’s practice, thought that this is a real shame, because long term conditions are really the bread and butter of our work. Why on earth is it so hard for us to get information that would help us in practice? Everybody was aware of this gap in their knowledge.
NASGP: Who took part in your GP survey?
I spoke to 15 GPs using what we call maximum variation sampling . I went all over the country: three people in Scotland, a couple of Wales, London, Midlands, Southwest. I interviewed a mixture of partners, salaried, locums, so I know that the work that I’ve done has addressed the learning needs of sessional GPs as well as the profession as a whole. And as I say, what came out of that was realising the similar experiences between all types of GPs of different types of practice and different backgrounds, from the 60-year-old partner to the GP locum in their 20s: they’re all feeling the same thing.
NASGP: How does GP Evidence work in practice?
We GPs have an appetite both for quick, easy information and for some depth.
Sometimes you want quick, rapid, easy to understand information that you can look up in a consultation and just get a nice plain answer, and you would maybe spend 20 seconds on that.
But we also, at times, want to think in quite complex ways, for example when we see people who’ve got complex illness or a number of comorbidities and lots of repeat prescriptions.
So the challenge when designing the website was trying to provide information that was simple and easy to access, but also underpinned by some background information that would enable GPs to think in a more complex way when they needed to about it, and integrate the new information into all their other knowledge.
For example, if you go to the lipids page, under ‘Treatment options’ you can go for ‘Statins for the primary prevention of cardiovascular disease’. You can select a Qrisk score, then you’ve got this graphic in front of you, with the smiley faces, and sentences in bold at the bottom. Summary statistics are on the right hand side. That’s an example of the core design feature of the website, which is giving rapid numerical information in a way that’s really easy to digest and was developed in co-design between GPs and web developers sitting together.
GP Evidence basically gives the same information in five different ways to suit different types of people: quick numbers, then linked information about where the evidence is from and what the quality of evidence is like and maybe some other queries like here. There’s a chunk of information there for when you’re having a cup of coffee after your morning surgery, and you want to reflect on information and learn a bit more deeply.
So you’ve got in-consultation use, and then content more suitable for bite-sized CPD learning activity and further reading – I hope, useful for the reality of GPs’ lives.
NASGP: What are the advantages beyond increasing GPs’ grasp of the evidence?
Nearly every doctor worries about, well, am I going to get into trouble if I don’t follow a guideline? Because when you have this kind of information, it is inviting you to share a decision with patients or to make a decision yourself as a clinician in a more independent way than you might if you’re just following a guideline. You can’t do proper shared decision making unless you have got this kind of information, really.
On the website, there’s a section on ‘Key concepts’ including medicolegal considerations. I wrote a piece about all this to try and support GPs to feel safe to use this kind of information.
For salaried GPs and GP locums specifically, someone told me in an interview that as a locum or salaried GP, you might find yourself getting nagged by the partners to tick all the QOF boxes. This might provide some support for GPs to make exceptions for QOF codes, supported by clinical evidence they can trust.