Welcome to the Hot Topics podcast from NB Medical with Dr. Neal Tucker. As we celebrate 25 years of NB Medical and the Hot Topics course, in this podcast we chat with co-founder Dr Simon Curtis about the changes in general practice and medical education since its inception, we discuss three of the most influential research papers over the era, and what the future may hold for GPs.
In research, we examine two new papers. The first in the NEJM is on semaglutide for patients with heart failure and preserved ejection fraction. Can it help improve symptoms and quality of life? Could it improve mortality? The second paper from the Lancet looks at a practice nurse-delivered insomnia intervention using sleep restriction therapy. Could this be a useful, cost-effective option for helping people struggling to sleep?
References
NEMJ Semaglutide + HFPEF with obesity
Lancet Nurse-led Insomnia intervention
www.nbmedical.com/podcast
Welcome to the Hot Topics podcast from NB Medical with Dr. Neal Tucker. As we celebrate 25 years of NB Medical and the Hot Topics course, in this podcast we chat with co-founder Dr Simon Curtis about the changes in general practice and medical education since its inception, we discuss three of the most influential research papers over the era, and what the future may hold for GPs.
In research, we examine two new papers. The first in the NEJM is on semaglutide for patients with heart failure and preserved ejection fraction. Can it help improve symptoms and quality of life? Could it improve mortality? The second paper from the Lancet looks at a practice nurse-delivered insomnia intervention using sleep restriction therapy. Could this be a useful, cost-effective option for helping people struggling to sleep?
References
NEMJ Semaglutide + HFPEF with obesity
Lancet Nurse-led Insomnia intervention
www.nbmedical.com/podcast
I went and did a shift in an old practice of mine the other day and to my surprise, I had a patient who I knew from many years ago booked in to see me. As he came through the door he said Doc, you're a sight for sore eyes. I thought he was really pleased to see me, but it turns out it was just a nasty case of Blethereitus. That may be the only original joke I've ever done on the podcast. It's not funny enough to make my wife laugh, but I think you might be a kinder audience and we all need a bit of lighthearted relief every now and again. Still, I am no stand-up comedian and this is no comedy podcast, so it's time to get on with the medicine.
Speaker 1:It's Friday, the 29th of September and this is the Hot Topics podcast. Welcome to the Hot Topics podcast from MB Medical. Thanks for joining us once again. Everyone Neil Tucker here to see us through the next 20 minutes or so on what's new and important for us to know about in general practice. This podcast is slightly earlier than our normal schedule and that's because it is our 25th birthday the Hot Topics course and MB Medical is 25 years old this month. To mark the occasion, we have got an interview with its co-founder, dr Simon Curtis. That'll be later on in the podcast and, before I forget if you are listening to this, on the day it comes out or on the Saturday. So by the 30th of September we still have our MB Plus birthday subscription offer. Mb Plus is a bargain anyway A little bit over £300 for a year. To come on all the online courses we do Watch all of them on demand, much more on the website and in nbmedicalcom as well, and all with £25 off at the moment. Grab it while you can. In research, today we're going to have a look at a new paper on semi-gluteide for heart failure with preserved ejection fraction, and also a paper on a practice nurse led intervention for insomnia.
Speaker 1:In the news this week, an RCGP survey of GPs has reported a worrying rise in the number of patients presenting with problems linked to the cost of living crisis, and it is really tough out there for a lot of the population, a lot of our patients, at the moment. I was reading this newspaper article where a journalist followed a secondary school headmaster from Oldham for the last academic year and they saw the deterioration that was happening due to the cost of living crisis in the pupils. Lots of them couldn't afford school dinners. Lots of them were having to essentially beg for scraps at the end of lunchtime. Substantial rises in the rate of evictions and families having to like whole families having to so for surf. This, of course, has an impact on a child's schooling. It also has an impact on their health. One of the big issues that the RCGP raises is a disconnect between funding for practices, deprivation and ill health. Practices looking after deprived populations are then often underfunded, limiting their ability to look after this group in the way that we would hope they should do. Inevitably, then, health inequalities grow. I don't really know where I'm going with this news story, except to say that with a little political will, you would think that this should be a disparity that would be straightforward to rectify. Unfortunately, what we seem to be lacking is that political will, so it's good to see the RCGP is trying to raise awareness of this issue and apply a bit of pressure.
Speaker 1:Now, in other news, I love this story. This is about ADHD drug shortages. Apparently, a combination of manufacturing problems and increasing global demand has meant that these medications are in short supply, including commonly prescribed ones like concerta and elvants. I'm speculating, but increased global demand must mean that America is just sucking up all the available supplies. It's a bit like they've done with semi-gluteide, so you can't get Uigovi for toffee in the UK. It appears that Novo Nordisk, which is a Denmark based pharmaceutical manufacturer, has had most of its supply of semi-gluteide sold to America. Now in the UK Uigovi, the weight loss brand of semi-gluteide, costs around £200 a month. For patients In America it costs around $2,000.
Speaker 1:I can only wonder why a manufacturer might prefer to sell most of their product to the States and I'm only speculating in the realm of ADHD drugs. But perhaps this same problem might contribute to a skew in global availability. In fact, the only reason I even raise this as a news item is because, reading in the BMJ, they report that the Department of Health and Social Care has advised GPs not to start new patients on several drugs for treating attention deficit hyperactivity disorder. I thought, well, thank you for that advice. But that does potentially show a lack of understanding in the system, because it's not going to be us that should be starting these medications. They need to see a psychiatrist. I can only imagine how disappointing it would be to be a patient having waited two years to get to see the specialist in clinic to get your diagnosis and then be told I'm really sorry, actually we don't have any medications to treat you. How about just running around the block a couple of times and doing a bit of mindfulness? Where this might end up being an issue for us in general practice is that some of our patients may just not be able to get the medications that they've been prescribed and been taking for years, and we just need to be aware that actually switching between these ADHD medications is not necessarily straightforward. They're not necessarily directly equivalent, and the MHRA has advised caution when switching between different long-acting formulations of particularly methylphenidate and recommend seeking specialist input to help with those switches.
Speaker 1:Okay, on to the research, and our first paper was published last week in the New England Journal of Medicine. This is semi-glutide in patients with heart failure with preserved ejection fraction and obesity. Heart failure with preserved ejection fraction, then, is a really hot topic at the moment, because it's being recognized that it's the predominant form of heart failure. Until very recently, there have been no medical treatments that improve prognosis for this patient group, and then, a couple of years ago, we had papers published on the SGLT2 inhibitors, shown that DAPA glyphosin and MPEG glyphosin could improve mortality, independent of whether a patient had diabetes or not, so the SGLT2 inhibitors were having some independent effect on the cardiovascular and hemodynamic system in the individual.
Speaker 1:It's widely acknowledged that age and cardiovascular complaints like hypertension and atrial fibrillation, are significant risk factors for the development of heart failure with preserved ejection fraction, but what isn't talked about so much is that obesity is also a major driver, and indeed the majority of patients with heart failure with preserved ejection fraction have obesity. Now, of course, excess weight is going to put extra strain on the heart, but in fact, in this group it goes well beyond that. So, for example, the visceral adiposity is linked with increased inflammation, and that can damage the heart as well. The bottom line is, if you have heart failure with preserved ejection fraction and obesity, on average, your symptom burden will be worse, your quality of life will be worse and your prognosis will be worse as well. So then, could the weight loss medicine Dajour semi-gluteide provide some benefit in this group?
Speaker 1:The GLP1 analogs, of course, have already demonstrated some cardiovascular benefits in patients with diabetes. Could they therefore benefit patients with established cardiovascular disease? So this was a randomized controlled trial in adults with heart failure with preserved ejection fraction. The ejection fraction had to be over 45% and then they were given either semi-gluteide 2.4 milligrams subcut weekly that's the weight loss dose of semi-gluteide rather than the type 2 diabetes dose of the drug or placebo injections for one year. Most of the patients were also on heart failure meds like beta blockers, aces, arbs, lute diuretics or firezides, and around 5% were on an SGLT2 inhibitor as well. Lots of these patients, unsurprisingly, had hypertension, af in heart disease. The average weight was 105 kilograms, the average BMI 37, predominantly a white population at 95%, with 5% being black American.
Speaker 1:So the primary end points that authors were looking for was percentage change in body weight and then also a change in the Kansas City Cardiomyopathy Questionnaire clinical summary score. This is a validated tool for assessing severity of heart failure and includes things like symptoms, but also physical function, quality of life and social function, so it gives a broad idea of how this condition is affecting patients. Initially I wondered how applicable this would be, because when I think of Kansas City I seem to think gambling in jazz. I wasn't sure how relevant this would be to the good people of Hull, but this is an internationally recognised scoring system, so I'll put my money back in my pockets and the trumpet back in its case. What they weren't really looking for in this study was harder end points like hospitalisation or death, and that's because this was an exploratory study.
Speaker 1:The size is relatively small and it's underpowered to accurately determine whether the drug can be more beneficial than placebo in these areas. They recruited 129 people. There was a discontinuation rate of 16% among that group. That was equal, interestingly, between semi-gluteide and placebo, and in the remaining participants there was a 13% reduction in weight in the semi-gluteide group compared with a 2.5% reduction in the placebo group. On the Kansas City questionnaire, which is scored out of 100, both groups saw some improvement, with the placebo group improving by nine points and the semi-gluteide group by 16.5%. The authors felt that that near eight point difference was substantial and highly clinically relevant. Now another interesting finding was around significant adverse events. We all know that the GLP1 analogs are associated with quite a lot of side effects, but what about significant adverse events? And in this study they actually showed that the rate of those was 50% lower in the semi-gluteide group compared with placebo, presumably due to the benefits that they're seeing from the medication.
Speaker 1:The authors concluded that in patients with heart failure with preserved ejection refraction and obesity. Treatment with semi-gluteide led to larger reductions in symptoms and physical limitations, greater improvements in exercise function and greater weight loss than placebo. Having another option to help with symptomatic management in this patient group is, of course, very welcome, but you and I know that the big question now will be what about mortality? What about hospitalizations from heart failure? And I have no doubt this study is going to prompt a larger exploration into this issue. In the meantime, the drug manufacturers are exploring a license for using this for symptomatic management.
Speaker 1:We are going to see semi-gluteide absolutely everywhere. Well, if we see it anywhere, if they sought the supply issues out, is it the drug or is it the weight loss that's leading to the improvement? Well, there's no doubt that weight loss is an important contributor to the gains they saw in this study, but also there may be other aspects of the medication that's leading to these improvements as well. So it potentially the authors speculate may have a favorable anti-inflammatory and hemodynamic profile, but they acknowledge that separating out what causes the benefit is tricky. For me, this paper also serves as a useful reminder. It's easy for us to think that our patient's symptoms may be purely attributable to being overweight or obese. But actually, if people are getting progressively fatigued, tired, their exercise capacity is going down, maybe they're getting some subtle fluid symptoms. We need to be thinking about heart failure as well and checking a BMP level is going to be really, really useful, just being mindful that obesity and certain cardiac medications they may already be taking can suppress that level of BMP and mask the diagnosis.
Speaker 1:Now onto our second piece of research, and we're going to look at a Lancet paper that published last week and this was the Habit Study Clinical and cost-effectiveness of nurse-delivered sleep restriction therapy for insomnia in primary care A pragmatic superiority open-label, randomized controlled trial. Now, when I first saw this paper, I was a little bit dismissive because I thought well, you know what lots of our patients can get computer-based CBT for insomnia, and there's good evidence to show that that is a very effective treatment. But you know what? Computers are not for everyone. Not everyone wants to do a medical therapy on an electronic device. Not everyone has access to that. Lots of people would prefer to actually speak to a real person.
Speaker 1:I'm not sure if my interest in this topic actually just represents my own personal biases, because I've gone from someone who's cancelled all of their paper journals because it's good for the environment. I can just look at everything online, and now I'm finding that I am addicted to screens and I always find I just want to pick up my phone and look at something, even though there's nothing really I need to look at. Do a few pointless internet searches, do a bit of doom scrolling on social media, and now I really think I need a substantial, prolonged digital detox and I need to go back to paper magazines. Perhaps then I am the target audience for a nurse-led insomnia intervention instead of being forced to do it on the computer and I'm sure I've mentioned this on the podcast before, along with a million other problems I seem to have had. But I am someone who is not a good sleeper. I think you can class the world as good sleepers and bad sleepers, and if you're a bad sleeper then it sucks to be you. When I was younger, let's say in my 20s, I had huge difficulties getting to sleep, and I remember spending hours awake at night, and then, finally, I put my headphones on with my Walkman and listened to Mariah Carey Music Box to try and lull myself off to sleep. Don't judge me.
Speaker 1:So this UK primary care based study recruited 642 patients. Everyone got a sleep hygiene booklet and then half of them also had sleep restriction therapy. That intervention was delivered by practice nurses. They had four hours of training on the subject and then they would see patients in four sessions over four weeks the first one to explain the theory and then the others to follow up and support the patient. The paper doesn't actually say how much sleep was restricted, although I guess that varies from person to person. But the key elements are setting a routine for when you're going to go to bed, setting a routine for when you're going to get up and making sure you stick to that and then avoiding daytime sleeping as well. The range of ages of participants was from 19 to 88, with a mean of 55 years. Perhaps you can teach old insomniacs new tricks.
Speaker 1:The main endpoint they were examining was self reported insomnia, based on the insomnia severity index, a validated tool for insomnia. Their key measurement was at six months, but they also checked how people were getting on at three and 12 months. So the results showed that at six months that insomnia severity index score was essentially 11 for the sleep restricted therapy group and 14 for the sleep hygiene group. So a three point mean difference which the authors felt was clinically significant. The sleep restriction group also reported better outcomes in mental health assessment, also in quality of life, even in days attending work. It just goes to show exactly how bad having bad sleep can be for people.
Speaker 1:The intervention, I think, was pretty cheap as well, so it cost on average 52 pounds per patient. The training for a nurse cost 32 pounds. On average the four sessions took 80 minutes of nursing time. In the authors cost effectiveness analysis this intervention came out very favorably, so I think this is a really nice study with really positive data. It's very relevant to general practice. It's relatively affordable and relatively time efficient.
Speaker 1:Sure, it doesn't quite have the scalability of doing internet based CBT for insomnia, but it does seem to be a really good option for people that may not want to go anywhere near a computer for this. They just don't get on with that at all and I can see this fitting into IAP services or even potentially PCNs, having a nurse who's leading on this who might be interested to go and do just four hours worth of training and then being able to deliver this to patients really effectively. It would be really interesting to see a trial where they compare nurse led sleep restriction therapy against computer based CBT for insomnia, and maybe we just throw a third arm in there for Mariah Carey on the Walkman. Just make sure you skip anything after 1995. Okay, that's enough for the research today and on to our interview Today on the podcast. I'm very lucky to be joined by Simon Curtis, who is one of the founders of MB Medical Education. He is the reason that I have a second job and why this podcast exists as well. Good morning, simon. How are you today?
Speaker 2:Yeah, good morning Neil. Thanks very much for finally asking me on the pod. It's only taken three years, but I'm very, very honoured to be here with you.
Speaker 1:And the reason that you're here today is because congratulations are in order. This is 25 years of the Hot Topics course now, so let me kick off with the question then, simon, so why did you start this and how did you start the Hot Topics course?
Speaker 2:Well, yeah, 25 years ago. It does make me sound pretty old actually, but it all started at a very drunken dinner party in East Oxford where I met my mate, phil, phil Nichols. Phil is a neurologist but he's also the CEO of MB Medical and he's a guy with sort of tremendous drive, vision and ambition. And he had already started a MB Medical actually to run MRCP courses because he'd just done MRCP and he sort of asked me whether or not I felt there was a need for a course for GPs. And you know, and I had a few drinks and so I said yeah, why not? What the hell?
Speaker 2:And so I did the first course in September 1998 with my friend and fellow GP, barry Ferguson, and I think we had 30 or 40 people turned up over two days. It really wasn't very good, but 30 or 40 trusting souls come and now we train around 25,000 GPs and primary care staff per year. We have MB Plus membership, which has become hugely popular as well. So yeah, it's fair to say it's been. It's been quite a journey over that time.
Speaker 1:I imagine that the course has evolved quite a lot. It must have been quite dramatic from where you started to where we are now. So how has the Hot Topics course changed? Mb Medical changed medical education in general? How's it evolved over the years?
Speaker 2:Well, it's evolved massively and it's been fascinating to see how it has. Actually, when we first started, we also run an MRCP course but it really, you know, rapidly became apparent to me that we needed to evolve into becoming more of a general GP update course. And at the time, you know, back then in the 90s, there are very few national guidelines. There was no NICE, no CKS. The Internet was in its infancy. Amazing, Interesting fact, Google also started in September 1998. Fair to say, they've been a bit more successful than us, but you know you couldn't just Google stuff. And also at the time it was the real start of the sort of the evidence based medicine movement.
Speaker 2:I trained in general practice in the mid 90s in Oxford and David Sackett, first prof of EBM, was there and was taught by him and is very inspirational guy. So all of those were sort of motives to really start the course. And I also felt we really needed GP to GP education, Because all GP education was led by specialists, it was all farmer sponsored, etc. But I also felt that, you know, we needed to make it a bit more punchy, a bit more fun, a bit more clinically orientated, you know, make it relevant. And that's what we really tried to do and that that evolution has been pretty continuous.
Speaker 2:Of course, there's also been this huge change in the way that the material is actually delivered. So when we started off, we were just using acetates and then we moved through physical slides and the carousels. Do you remember them? I remember one of those caught fire once in Leeds. That was a bit of a drama the introduction of PowerPoint and how unreliable early digital projectors were. Moving through all of that and about the time you joined, I guess, was when we were starting to move into big lecture halls and theaters. And then, of course, there was the big change to webinars, online learning, which really accelerated, of course, during the pandemic. The change has been enormous.
Speaker 1:General practice. That must have changed quite a bit over 25 years as well. How does being a GP now compare with being a GP 25 years ago at the inception of the Hot Topics course?
Speaker 2:Well, I think both the quality and the workload has sort of massively increased over that amount of time.
Speaker 2:Well, no, it's incredible to think of it now, but when I started Hot Topics I was a nine session GP partner and still finding time to do Hot Topics as well and virtually all GPs were partners and virtually you know, all of them were sort of doing nearly full time when I started.
Speaker 2:Of course you did see complicated patients and complex stuff, but clinics overall were a lot easier. There were a lot of pill repeats, bp checks, coughs and colds were. These were five minute consults in every surgery and of course also there was a lot less bureaucracy. There was no appraisal, no revalidation, no quaff, no CQC referrals, etc was a lot easier. So essentially the workload was just a lot less. And now GPs have become general physicians, pediatricians, psychiatrists, geriatricians, which are sort of everything to everybody. And whilst that makes the job much more interesting and I think it also makes it much more rewarding and stimulating, undoubtedly it's much more challenging, particularly with the huge sort of bureaucratic workload, but the broadening of the skill set in general practice and the rising of the quality of it, I think has been really really quite significant.
Speaker 1:You've highlighted some of the challenges of being a GP. Now have there been significant challenges from the company perspective, from mb medical?
Speaker 2:Yeah, definitely, yeah, nothing. I think probably the biggest challenge actually was getting started in the first place, because at the time there was no real sort of independent GP to GP education. I mean the big, the big organizations like, you know, the royal college, of course they ran courses and education and there was lots of farmer sponsored stuff, but there were no independence out there, if you like that we're doing it, so actually just getting started. You know it was a major challenge and you know feel Barry and I have to work really hard on that for quite a long time to get things actually started and then, of course, things then start to sort of snowball and improve. So that, I think, was the biggest challenge.
Speaker 2:And then of course, the pandemic was absolutely huge challenge because by that time we had just started doing webinars just before the pandemic and we'd invested a lot in it, in the business, so that we was set up ready to sort of do that. But essentially it was still very much A lecture hall based education that we had, and so overnight there was just this really sort of dramatic change and we've got this huge list of courses that we just had to cancel. But we very rapidly started to see the opportunities of the of the webinars as well. Not only Were they the only practical option during the pandemic is that for most people they're just much more convenient, cheaper, greener, saving people huge amount of time, which is one thing that she is really really need and value but also they could be much more interactive.
Speaker 2:So the learning with webinars could actually be better and I think the other thing we've learned from that is different people just learning different ways. People have got very, very different learning Styles and so we've got different formats to suit those styles and that's what we very much got with, you know, with NB plus us, a sort of subscription modules. You can do these interactive webinars or you can do them on demand in chunks. They're interactive modules, the hot topics takeouts in podcasts form. So you've got these different Formats that can suit your individual learning style.
Speaker 1:Said, the pandemic undoubtedly was a massive challenge, but out of it well, as people always say about the pandemic, you know is sort of 10 years worth of Evolution happened in a year here's the last of my questions, and this is the most challenging one for you today, which is can you pick out your three favorite, or perhaps the most influential papers that have been published over the last 25 years? What really stands out as changing practice?
Speaker 2:That is a big question. So desert island disk is sort of like evidence based medicine. Desert island disks moment. I think well, undoubtedly when we started in 1998 and that was when the UK PDS study was published, the UK prospective diabetes study and that was massive and prior to this there was there was a real lack of evidence that improving control really made much of a difference in in type two diabetes and when I was a GP trainee I was taught by GPs in my practice should just manage it. Symptomatically, we just didn't know whether or not type control of sugar or blood pressure really made a big difference in the UK.
Speaker 2:Pds was the first really big high quality trial to really examine this and there were several different publications that came out of it and they sort of first couple of years of hot topics. This featured really a lot and it showed that tight control did improve small vessel complications. It showed that met forming reduced diabetes related complications and all cause mortality and should be first line in In patients with type two diabetes and also it showed tighter blood pressure control really improved outcomes and I went back and looked at this paper yesterday and they compared tight control, which was defined as less than 150 over 85, with less tight control group which was less than 180 over 105. So that that was how very different it was. Not surprisingly, it showed if you reduce people's blood pressure a lot less than 180, you have the incidence of stroke. So that was. That was a really, really massive study and, I think, really indicative of how evidence based medicine, which had very much been thought of as sort of the domain of secondary care, how it was really important for primary care.
Speaker 1:Those figures those figures would certainly have made quite a lot easier.
Speaker 2:They certainly would have made quite a lot easier. But there were lots of people wandering around with those really high, very high blood pressures and there was this feeling that, well, just when you get older you just have a very high systolic blood pressure and isolated systolic hypertension wasn't the thing necessarily you should be worried about.
Speaker 1:You have a few strokes here and there. You know what's a, what's a stroke between friends exactly.
Speaker 2:So that would be my first choice from right when we started, and then Probably my second choice, I think, was probably in the sort of early sort of 2000s, and this was looking at increased stroke risk and mortality with anti-psychotics in dementia and older people. At the time, virtually all older people with either dementia or behavioral problems were hugely over-medicated with anti-psychotics risperidone, low dose haloperidol etc. And were basically just zonked out a lot of the time. And then in the early 2000s, evidence started to emerge that we were discussing on the course linking atypical anti-psychotics with increased risk of stroke and mortality, not just in people with dementia but in older people in care homes. And then in 2008 there was this BMJ study showing that all anti-psychotics increased the risk of stroke and mortality, not just in dementia but in older people, particularly in care homes. And that was the point on the course where we started trying to sort of link what we were doing with quality improvement I don't even think that phrase really existed at the time Presenting this information and saying it's a really good thing to sort of go back into practice to look at prescribing of anti-psychotics in elderly people and people with dementia. We're not taking the credit for this, but sort of nationally, there's now been this massive reduction in prescribing of anti-psychotics in that group.
Speaker 2:And then the third one, therapeutics One, which is the Reli study in 2009. So the Reli study was the study looking at the first NOAC, as they were called at the time, dabby Gatran. So Dabby Gatran. I remember reading this paper in the New England Journal, this drug with this sort of crazy name, which was a direct thrombin inhibitor. I had no idea what that was, but it was a drug that was as good as warfarin at preventing strokes in atrial fibrillation, but you didn't need to do iron arm monitoring. It was a steady dose type thing. It was a predictable therapeutic response and it was a real wow moment reading that paper, thinking thinking, oh, this is just going to be an absolute game changer.
Speaker 2:And I remember presenting that paper on the course and sort of people again thinking, wow, is this something we're really going to be able to do in general practice is have alternatives to sort of you know warfarin. And of course, the irony is no one uses Dabby Gatran now. Of course it's been superseded by all the other DOACs that have come along, but it was a real sort of you know, game changer in therapeutics and you get these. I mean again. I get similarly, I guess, with DAPA heart failure trial, when showed that you know, dapa glyphosin improved heart failure outcomes independent of diabetes. There's been quite a few of those over the years where there's been this sort of step change in therapeutics, and the Rely study is one that stands out.
Speaker 1:Well, I would ask one final question, which is where do you think general practice is going to be in 25 years time, where do you think therapeutics are going to be in 25 years time and where do you think medical education will be in 25 years time? But actually I think, as we've seen, given the huge changes we've experienced over the last 25 years, I'm not even sure that it's worth making a prediction. What do you think?
Speaker 2:Oh yeah, I disagree. Now I think it is worth. I think it is worth making very, very simple predictions, and I think very, very simple prediction is that the future of general practice is absolutely secure. Whatever else is happening in medicine, you're always going to need highly skilled, trained generalists in the community. It's the only way to deliver an effective and, importantly, a sort of cost effective health service. So the future of general practice is absolutely secure. It will evolve further and, I think, become even more interesting than it sort of currently is.
Speaker 2:We've got huge challenges to overcome, particularly the workforce crisis, workload crisis. The workload has got to be made much, much more manageable. As you've said on the pod many times before, and I absolutely, totally agree general practice needs to be changed so that there's a sort of you know, a model of working so people are able to work full time in general practice and be paid full time in general practice. I think you know you need 15 minute consultations, max 15 minutes, 15 patients per session, but for every one or two sessions, you know you need a session or two to do all the admin and the bureaucracy that goes with that, and I think if you created that work environment, people would be working full time again, but I think the future of general practice is absolutely secure and it will be bright. And if anyone's listening who's a trainee or thinking of becoming a GP trainee, absolutely do it Really. It's a yeah, it's a fantastic job where you make a real difference to people's lives and that's what we want to do, I think.
Speaker 2:With therapeutics, we're discussing on our upcoming course this really fascinating new guideline from NICE about genetic testing of clopidogrel to see whether or not people are resistant to clopidogrel after a stroke or TIA. It's really fascinating stuff and I think pharmacogenetics and moving to more individualized precision based medicine depending on people's genetic profile, I think is something a really exciting avenue that we're going to go down over the next decade or two. And in terms of medical education, the opportunity stroke threat, of course, is where artificial intelligence is going to sit in that Well, as in sort of you know clinical care as well. And, just like when we started MB Medical, we were at the real infancy of the internet and we're not sure how things would develop with the internet. We're very much in that space now with artificial intelligence, but it will undoubtedly have a huge impact on it, hopefully in a very, very positive way.
Speaker 1:Right, simon Curtis, gp. Co-founder of MB Medical Education. Thanks for joining us on the podcast today. Great to chat to you. Sure, we'll get you back at some point. We'll see you on this again. I would love to thank you. Well, I hope you enjoyed those insights everyone. Thank you for listening today. Do remember to check out the MB Medicalcom website for all the courses that are coming up. We've got loads of live courses which are new or updated, which are going to come over the next few weeks and months. And don't forget, you can always get in touch. Hot topics at MBmedicalcom is our email, or find us on what used to be called Twitter and is now called something else at GP Hot Topics, facebook too. And, as ever, remember to enjoy yourselves. You're doing a great job. We'll see you next time. Bye, bye.