Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

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My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

'Drama classes help GPs handle difficult patients' c/o BBC

'Hull Truck Theatre has just won the Innovation prize at the Stage Awards for their new training scheme for GPs. Associate Director Tom Saunders and GP Dr Eman Shamsaee discuss why drama classes are helping doctors treat patients.' 

BBC Radio 4 'Front Row' https://www.bbc.co.uk/sounds/play/m002q2jz (15 mins ...)

◇

Holly Phillips, East Yorkshire and Lincolnshire and Ian Youngs, Culture Reporter

Published - 21 January 2026

'A theatre company is using drama training to help doctors deal with challenging patients.

Hull Truck Theatre's classes feature actors performing difficult GP consultations, with GPs giving feedback before taking over the consultation themselves.

The theatre recently won the Innovation Award at the Stage Awards for the programme.

Dr Eman Shamsaee, who has taken part in the training scheme, described it as a "really creative way of doing GP training".'

BBC News:  Drama classes help GPs handle difficult patients

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The training programme has completed its pilot stage and is now in the delivery phase

A reminder of co-working to deliver STORM training with a Clinical Psychologist colleague. 

See also: 'communication' : 'primary care' : 'GP' : 'drama'

Dear Doctor, I have a list . . .

It seems reasonable to suggest that my trips to see the GP as a child:

"What's the problem Mrs Jones?"

"It's Peter, he's not eating!"

"Well, does he seem ill? ... Is he lying down all the time?"

"No, he's running around all day"

"Well he sounds OK but let's check" ... ... ...

"Say arr!"

 (That's to me - not you reader!)

"Argh!"

"Mmm.. ok, ok. ... What does he eat?"

"Tomato soup, chips, chicken, beans on toast, raw carrot, boiled egg."

"Oh! And jam butties!"

"Well he's of slim build, no doubt underweight, but he's fine. Keep the jam butties rolling, and I suspect he'll keep running around."

- were in the days pre-one-problem-per-visit to the surgery. Even now I wonder is this an urban (rural) myth. But then it rears itself with a comment by family, or overheard. The 1960s and 1970s were a different time, a different age. We always saw the same doctor. Continuity mattered then. Thankfully, I was not a regular 'visitor', or the more derogatory term frequent flyer.

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Ever since starting in the NHS as a nursing assistant, you became aware of the anxiety provoked by many patients when it is their turn to see the doctor. Being asked to bring the patient and any relative(s) through. It often entailed a walk.

I remember one instance their being 12 professionals. Learners can soon increase numbers and restrictions were imposed. Voices were raised. Patients did see the doctor separately. Back in 1980s, I became a CMHN (CPN) in 1985, I used to encourage patient's to prepare, to make notes of points - questions they wanted to ask. I framed it as their time, their opportunity. A learning opportunity too. Of course, humour always needs to be used carefully, but on occasion we would joke about walking into the meeting with a list.*

In case of long-term mental illness families are also greatly involved. Sometimes a case review would take place in the patient's home. If it's care in the community, delivered by the community team then surely the administration can be organised in support?

At times, I would offer to assist and the team were always responsive. This role of advocacy has changed, transformed over the decades, but it is still there. As a nurse you listen for the voice: but have to be ready to 'pick this up' on another's behalf. Ready

*Lists: Long a tool for safety and situational awareness.

Social Prescribing Student Champion Scheme - APPLICATION FORM

We are looking for champions!!! Student Nurses, Midwives, AHPs and Medics! Come join us!!! Share on all platforms as there is only one week remaining before the deadline! @LJMU_MHN_Soc @LJMU @LJMU_Health #socialprecribing #supportinthecommunity #futureofhealthcare https://t.co/p0BoW7CY7H

— student_ nurse _2021 (He/Him/His) (@STN_JW2021) October 6, 2022

 
APPLICATION FORM

There is a QR code to apply too.

Court of Protection: Supported Decision-Making - case of P

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Decisions on: residence, care, alcohol consumption, depression reluctant and distrustful of (statutory) services Who would P feel she could trust  to help with decision? psychological interventions P. being listened to ... feel safer, healthier, in control, respected	detox placement  (identified by LA) place - area physical health services Access to knowledge - local expert - 'signposting'
Asking why and why again ... distrust of social workers sister and neice primary people of trust then GP. So family and GP became more involved. engagement	Local Authority [LA] Social workers and mental health support workers agreed to take a back seat CRPD Committee Mental Capacity Act Judge, Lawyer option to introduce elements of supported decision-making into the Court of Protection

This morning in a Court of Protection case, Macdonald J endorsed a supported decision-making approach. P has alcohol dependence & depression. She lacks capacity to make decisions about residence, care and alcohol consumption. (1)

— Oliver Lewis (@DrOliverLewis) April 3, 2019

Patient Education: Stable - Unstable Plaques c/o twitter ...

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'The patient' Insight, Awareness, Understanding Attention, Engagement, Recall Health Literacy	Stable-Unstable Plaques Statins Post Myocardial Infarction Evidence-Based Care
Love this unstable plaque explanation - why this man should take a statin post MI @Channel4 #GPsBehindClosedDoors - please namecheck this nurse if you know her @theRCN @RCNconnects @NursingTimes @TheBHF @BritishCardioSo @DrPascalMeier @Heart_BMJ @JACCJournals #medshr pic.twitter.com/r1t0VCL0SL — Dr Asif Qasim (@DrAsifQasim) December 5, 2018	Policy Post MI Intervention or Pre MI? Clinics ('Real time'?) Public Health Funding

Social prescribing: c/o @TheKingsFund - Three questions

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Does it work?	What is it?
What is #socialprescribing? Does it work, and how does it fit in with wider health and care policy? A quick refresher ahead of our event tomorrow… https://t.co/46cJqjBKeR — The King's Fund (@TheKingsFund) November 5, 2018	And how does it fit in  with wider health and care policy?

Social prescribing is not a quick fix, a social distraction from a clinical problem. How this is approached - negotiated - will be a clear factor in the shared success of social prescribing as an effective, intervention for the person concerned, the NHS AND society.

"One-size-fits-all" Assurance of Insurance needed?

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mental health problems affect Self-employed, single No previous history of MH problems PURPOSE# Psychology - Counselling	12.5 million adults - 1 in 4 PROCESSES (automated?)* 'Life cover' Insurer access to GP record - deemed high-risk 500,000 people affected by
Untimely death of a parent Mother killed by drug-using driver Refused IVF treatment PRACTICE	insurance company POLICIES driver jailed Voided application for life cover (figures) suggest insurers reject up to 625,000 people a year By law ins. companies cannot discriminate

*Need to discuss an application with a person, fill in 'gaps' then less likely to become subjected to an algorithm and an automated rejection.

^# What were the reasons for referral to psychology and counselling?

My source:
Miller, L. (2018) My fight to get life cover after mental health trauma, The Daily Telegraph, Money, 22 September, pp.1-2.

See also: https://www.telegraph.co.uk/insurance/life/get-life-insurance-mental-health-problem/

Technology can, will and is helping to 'disrupt' the insurance market.

Primary Care and the GP crisis: Individual - Group [Consultations]

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Mental health (use of groups) One-to-One Interpersonal skills Psychological therapies PURPOSE Psychotherapy	Time, Place Efficiency Cost-effectiveness Evidence-based same conditions PROCESS
Group Consultations Group Therapy - an established therapeutic modality Group CBT for Older Adults PRACTICE	POLICY Treatment Therapy Education Doctor or Nurse led other disciplines too...

It’s great to hear #RCGP lead acknowledging the value of group consultations. Many of these pilots have been formulated & run by #nurses in general practice. It’s a shame their work wasn’t acknowledged on .@BBCr4today @weGPNS @theRCN https://t.co/zh4H7swoUv

— RCN GPN Forum (@RCNGPNForum) October 6, 2018

My source:
The Telegraph, GPs to see patients in groups of 15

@weGPNS - text corrected from original.

GP launches YouTube health films

Bob Pyke posted the following today:
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I wrote about this about a year ago and they recently updated it, but it is still pretty cool.
http://www.builthsurgery.co.uk/

A GPs' surgery in mid Wales has launched a series of health education films on YouTube, better known as a website featuring home videos.

Advice about flu vaccination and cervical screening are two of the topics covered by Builth and Llanwrtyd Medical Practice in Powys.

Doctors said they wanted to help educate their 7,700 patients and a wider global audience.

Last year, the surgery launched a series of podcasts to advise patients.

YouTube allows users to upload their home videos and other clips online.

Dr Richard Walters, who helped to develop the practice's project, said surgeries normally printed leaflets to advise patients, but added that things were changing.

He told the Western Mail newspaper: "There are a lot of things that we do in a GP practice that have to be conveyed to patients, some of which are not easy to demonstrate within the surgery.

"Sometimes getting patients to watch a quick video on the computer screen is a lot easier."

He added: "We are a practice in rural mid Wales, shops in Hereford and Aberystwyth are an hour away, Cardiff an hour-and-a-half, so although broadband access is not ideal, people tend to use the internet for all sorts of things."

The practice, which covers more than 500 square miles (1,295 sq kms), hopes its advice online will avoid unnecessary travelling to a see a doctor. The videos include tips about asthma inhalers, smear testing, blood sugar testing and the winter flu vaccine, and are made by two practice nurses.

New topics are planned to be added every month. As well as being available on YouTube, the videos are posted on the practice's own website and can be downloaded onto an MP3 player. The surgery is no stranger to using modern technology to get across its health messages to patients. Last year, it launched podcasts demonstrating, among other topics, how to use an asthma inhaler properly.

Story from BBC NEWS:
http://news.bbc.co.uk/1/hi/wales/mid/6234141.stm