Sam Finnikin
@finnikin.bsky.social
GP, academic, father.
Believe healthcare can do better for people through personalised care.
Own opinions, obvs.
Believe healthcare can do better for people through personalised care.
Own opinions, obvs.
Reposted by Sam Finnikin
And at this point a reminder of the Naci paper. High prices = opportunity cost and lost lives in net terms
This is where the primary care budget is!
www.thelancet.com/journals/lan...
thread here
bsky.app/profile/fell...
This is where the primary care budget is!
www.thelancet.com/journals/lan...
thread here
bsky.app/profile/fell...
September 28, 2025 at 9:31 PM
And at this point a reminder of the Naci paper. High prices = opportunity cost and lost lives in net terms
This is where the primary care budget is!
www.thelancet.com/journals/lan...
thread here
bsky.app/profile/fell...
This is where the primary care budget is!
www.thelancet.com/journals/lan...
thread here
bsky.app/profile/fell...
My thought looking at this is that it wasn’t written by someone working in primary care.
More and more specialists are expecting us to do more and more tests prior to referral.
(And there’s more and more specialists whilst GP numbers are nowhere near keeping up)
More and more specialists are expecting us to do more and more tests prior to referral.
(And there’s more and more specialists whilst GP numbers are nowhere near keeping up)
More people are turning to primary care providers for advice on infertility. What should clinicians consider in these discussions, and when ordering tests?
Includes a #BMJInfographic on infertility testing
www.bmj.com/content/390/...
Includes a #BMJInfographic on infertility testing
www.bmj.com/content/390/...
August 19, 2025 at 12:21 PM
My thought looking at this is that it wasn’t written by someone working in primary care.
More and more specialists are expecting us to do more and more tests prior to referral.
(And there’s more and more specialists whilst GP numbers are nowhere near keeping up)
More and more specialists are expecting us to do more and more tests prior to referral.
(And there’s more and more specialists whilst GP numbers are nowhere near keeping up)
Reposted by Sam Finnikin
Most penicillin 'allergies' aren't real, finds a major trial run by our CTU & led by @universityofleeds.bsky.social.
88% of patients with a penicillin allergy label had it safely removed after testing, meaning:
✅ better treatment for patients
🦠 a vital step in tackling #AntibioticResistance.
88% of patients with a penicillin allergy label had it safely removed after testing, meaning:
✅ better treatment for patients
🦠 a vital step in tackling #AntibioticResistance.
Most penicillin 'allergies' not real, finds major trial coordinated by departments Primary Care Clinical Trials Unit
A department Clinical Trials Unit coordinated trial has found most penicillin 'allergies' are not real. Safely removing these incorrect labels can lead to better patient treatment and is a vital step ...
www.phc.ox.ac.uk
July 16, 2025 at 8:25 AM
Most penicillin 'allergies' aren't real, finds a major trial run by our CTU & led by @universityofleeds.bsky.social.
88% of patients with a penicillin allergy label had it safely removed after testing, meaning:
✅ better treatment for patients
🦠 a vital step in tackling #AntibioticResistance.
88% of patients with a penicillin allergy label had it safely removed after testing, meaning:
✅ better treatment for patients
🦠 a vital step in tackling #AntibioticResistance.
Reposted by Sam Finnikin
Fab thread on the ‘genomics revolution’.
1. Might be helpful for a few people with conditions that are closely genetically linked.
2. Most conditions aren’t.
3. The cost will be enormous
4. Lots of people will become unnecessarily anxious
4. Telling people their risk doesn’t change behaviour
1. Might be helpful for a few people with conditions that are closely genetically linked.
2. Most conditions aren’t.
3. The cost will be enormous
4. Lots of people will become unnecessarily anxious
4. Telling people their risk doesn’t change behaviour
July 3, 2025 at 2:29 PM
Fab thread on the ‘genomics revolution’.
1. Might be helpful for a few people with conditions that are closely genetically linked.
2. Most conditions aren’t.
3. The cost will be enormous
4. Lots of people will become unnecessarily anxious
4. Telling people their risk doesn’t change behaviour
1. Might be helpful for a few people with conditions that are closely genetically linked.
2. Most conditions aren’t.
3. The cost will be enormous
4. Lots of people will become unnecessarily anxious
4. Telling people their risk doesn’t change behaviour
Reposted by Sam Finnikin
Ministers - more health checks are not game changing, actual action on public health would be game changing
as per @sebrees1.bsky.social & co bsky.app/profile/sebr...
and
@felly500.bsky.social hsj.co.uk/policy-and-r...
and @swoolnoughtkf.bsky.social
hsj.co.uk/service-rede...
as per @sebrees1.bsky.social & co bsky.app/profile/sebr...
and
@felly500.bsky.social hsj.co.uk/policy-and-r...
and @swoolnoughtkf.bsky.social
hsj.co.uk/service-rede...
April 24, 2025 at 1:36 PM
Ministers - more health checks are not game changing, actual action on public health would be game changing
as per @sebrees1.bsky.social & co bsky.app/profile/sebr...
and
@felly500.bsky.social hsj.co.uk/policy-and-r...
and @swoolnoughtkf.bsky.social
hsj.co.uk/service-rede...
as per @sebrees1.bsky.social & co bsky.app/profile/sebr...
and
@felly500.bsky.social hsj.co.uk/policy-and-r...
and @swoolnoughtkf.bsky.social
hsj.co.uk/service-rede...
Reposted by Sam Finnikin
For guidance, advice, campaigns and examples of good practice to tackle medicine waste and improve adherence, head over to our resources. www.prescqipp.info/our-resource...
@pharmdeclares.bsky.social @tonyavery.bsky.social
@pharmdeclares.bsky.social @tonyavery.bsky.social
April 8, 2025 at 8:35 AM
For guidance, advice, campaigns and examples of good practice to tackle medicine waste and improve adherence, head over to our resources. www.prescqipp.info/our-resource...
@pharmdeclares.bsky.social @tonyavery.bsky.social
@pharmdeclares.bsky.social @tonyavery.bsky.social
Reposted by Sam Finnikin
Looks like a snake oil epidemic on social media: “We analysed almost 1,000 social media posts about 5 popular medical tests. Most were utterly misleading” #overdiagnosis
theconversation.com/we-analysed-...
theconversation.com/we-analysed-...
We analysed almost 1,000 social media posts about 5 popular medical tests. Most were utterly misleading
87% of posts mentioned the benefits of the tests, while only 15% mentioned potential harms.
theconversation.com
February 26, 2025 at 8:06 PM
Looks like a snake oil epidemic on social media: “We analysed almost 1,000 social media posts about 5 popular medical tests. Most were utterly misleading” #overdiagnosis
theconversation.com/we-analysed-...
theconversation.com/we-analysed-...
Reposted by Sam Finnikin
Great to speak to @peteredwards.bsky.social for the @bjgp.bsky.social podcast about safety netting in general practice. Some great tips for practice - listen here! 👇 bjgplife.com/episode-196-...
Episode 196: How to approach safety netting in general practice
In this episode, we talk to Dr Pete Edwards about effective safety netting practices.
bjgplife.com
February 25, 2025 at 12:26 PM
Great to speak to @peteredwards.bsky.social for the @bjgp.bsky.social podcast about safety netting in general practice. Some great tips for practice - listen here! 👇 bjgplife.com/episode-196-...
Reposted by Sam Finnikin
podcasts.apple.com/gb/podcast/t... here’s an 18 min chat w Jonathan about statins in older people. Maybe you know someone like Mrs Evans …
12. Sensible prescribing in older people with Jonathan and Lucy; Statins
Podcast Episode · Talking Meds - A PrescQIPP podcast · 21/02/2025 · 19m
podcasts.apple.com
February 23, 2025 at 4:17 PM
podcasts.apple.com/gb/podcast/t... here’s an 18 min chat w Jonathan about statins in older people. Maybe you know someone like Mrs Evans …
Reposted by Sam Finnikin
**NEW BMJ PAPER**
"Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches"
- most models provide just a risk estimate
- we argue for presenting associated uncertainty too
- includes pros, cons, PPIE & methods
Hope helpful!
www.bmj.com/content/388/...
"Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches"
- most models provide just a risk estimate
- we argue for presenting associated uncertainty too
- includes pros, cons, PPIE & methods
Hope helpful!
www.bmj.com/content/388/...
Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches
Clinical prediction models estimate an individual’s risk (probability) of a health related outcome to help guide patient counselling and clinical decision making. Most models provide a single point es...
www.bmj.com
February 13, 2025 at 11:13 AM
**NEW BMJ PAPER**
"Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches"
- most models provide just a risk estimate
- we argue for presenting associated uncertainty too
- includes pros, cons, PPIE & methods
Hope helpful!
www.bmj.com/content/388/...
"Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches"
- most models provide just a risk estimate
- we argue for presenting associated uncertainty too
- includes pros, cons, PPIE & methods
Hope helpful!
www.bmj.com/content/388/...
Reposted by Sam Finnikin
What is best practice for giving 'safety netting' advice to parents of acutely unwell children in general practice & what role might AI play? Mavin Kashyap, Damian Roland & Peter Edwards consider the evidence in this recent @bjgp.bsky.social editorial.
bjgp.org/content/75/7...
#GPsky #PrimaryCare
bjgp.org/content/75/7...
#GPsky #PrimaryCare
February 6, 2025 at 1:30 PM
What is best practice for giving 'safety netting' advice to parents of acutely unwell children in general practice & what role might AI play? Mavin Kashyap, Damian Roland & Peter Edwards consider the evidence in this recent @bjgp.bsky.social editorial.
bjgp.org/content/75/7...
#GPsky #PrimaryCare
bjgp.org/content/75/7...
#GPsky #PrimaryCare
Reposted by Sam Finnikin
Implementation of clinical pharmacists in #PrimaryCare resulted in improvements in prescribing quality, with reductions in the total number of opioid prescriptions and total costs of medicines per patient doi.org/10.3399/BJGP...
January 29, 2025 at 7:30 AM
Implementation of clinical pharmacists in #PrimaryCare resulted in improvements in prescribing quality, with reductions in the total number of opioid prescriptions and total costs of medicines per patient doi.org/10.3399/BJGP...
Glad this group have published this thoughtful challenge to current practice. We’ve lost our way somewhat and we wont get back on track without strong and reasoned voices.
Mandatory "prevention" is swallowing up skilled time and imposing an impossible load on those trying to help ill people, i.e. GPs. So thrilled to be on the authorship of this plea for a restoration of balance and due roles: www.bmj.com/content/388/...
Sacrificing patient care for prevention: distortion of the role of general practice
Expansion of preventive clinical recommendations in primary care has had the unintended consequence of destabilising this foundation of the healthcare system, argue Minna Johansson and colleagues
Fo...
www.bmj.com
January 21, 2025 at 10:58 PM
Glad this group have published this thoughtful challenge to current practice. We’ve lost our way somewhat and we wont get back on track without strong and reasoned voices.
Reposted by Sam Finnikin
Mandatory training has lost its way.
Once a tool for learning critical skills, it's now a growing list of endless requirements. If everything is mandatory, is anything truly essential?
🧵
Once a tool for learning critical skills, it's now a growing list of endless requirements. If everything is mandatory, is anything truly essential?
🧵
January 17, 2025 at 11:17 AM
Mandatory training has lost its way.
Once a tool for learning critical skills, it's now a growing list of endless requirements. If everything is mandatory, is anything truly essential?
🧵
Once a tool for learning critical skills, it's now a growing list of endless requirements. If everything is mandatory, is anything truly essential?
🧵
Reposted by Sam Finnikin
It’s Twixmas! Why not catch up on some of the great medicines related chat you have missed out on in 2024. Some of our best episodes and fun-related CPD guaranteed.
December 27, 2024 at 2:38 PM
It’s Twixmas! Why not catch up on some of the great medicines related chat you have missed out on in 2024. Some of our best episodes and fun-related CPD guaranteed.
Reposted by Sam Finnikin
ICYMI - the world of medicines in 2024 Wrapped by the five apothecaries!
🚨 The Aural Apothecary Almanac 2024. Weight loss drugs, Assisted dying and the Weight of the BNF!
Join the us around the fire as we wrap up the year with our 2024 review featuring our friends @clarepharmacy.bsky.social and @jonathanunderhill.pharmsky.app
www.theauralapothecary.com/the-aural-ap...
Join the us around the fire as we wrap up the year with our 2024 review featuring our friends @clarepharmacy.bsky.social and @jonathanunderhill.pharmsky.app
www.theauralapothecary.com/the-aural-ap...
The Aural Apothecary Almanac 2024. Weight loss drugs, Assisted dying and the Weight of the British National Formulary
Pull up a chair and join the Three Apothecaries around the fire as we wrap up the year with a lively chat featuring friends and colleagues Clare Howard and Jonathan…
www.theauralapothecary.com
December 22, 2024 at 11:32 AM
ICYMI - the world of medicines in 2024 Wrapped by the five apothecaries!
I agree.
www.bmj.com/content/387/...
Direct access to Knee MRI from GP is not, on the whole, helpful. I don't have access and don't want it. Same with back and head MRI. I can honestly say I can't order them so don't have to engage in long and fruitless conversations about why they aren't indicated
www.bmj.com/content/387/...
Direct access to Knee MRI from GP is not, on the whole, helpful. I don't have access and don't want it. Same with back and head MRI. I can honestly say I can't order them so don't have to engage in long and fruitless conversations about why they aren't indicated
More scans, more problems—let’s fund prevention instead
Mathew discusses GP access to magnetic resonance imaging (MRI).1
Multiple studies have been published in which patients without symptoms underwent MRI of the knee and were found to have abnormalities...
www.bmj.com
December 19, 2024 at 8:56 AM
I agree.
www.bmj.com/content/387/...
Direct access to Knee MRI from GP is not, on the whole, helpful. I don't have access and don't want it. Same with back and head MRI. I can honestly say I can't order them so don't have to engage in long and fruitless conversations about why they aren't indicated
www.bmj.com/content/387/...
Direct access to Knee MRI from GP is not, on the whole, helpful. I don't have access and don't want it. Same with back and head MRI. I can honestly say I can't order them so don't have to engage in long and fruitless conversations about why they aren't indicated
Important piece by @lucypgeridoc.bsky.social et al in @bmj.com this week.
We need better data on harms and benefits of heart failure treatments in frailty to inform SDM. Pts deserve better
www.bmj.com/content/387/...
We need better data on harms and benefits of heart failure treatments in frailty to inform SDM. Pts deserve better
www.bmj.com/content/387/...
Appropriate management of heart failure in older people with frailty
Guideline directed medical therapy for heart failure for older people with frailty may do more harm than good, say Henry Woodford and colleagues
The management of heart failure is evolving. Recent c...
www.bmj.com
December 19, 2024 at 8:30 AM
Important piece by @lucypgeridoc.bsky.social et al in @bmj.com this week.
We need better data on harms and benefits of heart failure treatments in frailty to inform SDM. Pts deserve better
www.bmj.com/content/387/...
We need better data on harms and benefits of heart failure treatments in frailty to inform SDM. Pts deserve better
www.bmj.com/content/387/...
Reposted by Sam Finnikin
NEW BRIEFING by @becksfisher.bsky.social in collaboration with Health Equity Evidence Centre calls for the outdated GP funding formula to be replaced by a needs-based payment to better address health inequalities. 💷
Read here: www.nuffieldtrust.org.uk/resource/fai...
Read here: www.nuffieldtrust.org.uk/resource/fai...
December 12, 2024 at 9:34 AM
NEW BRIEFING by @becksfisher.bsky.social in collaboration with Health Equity Evidence Centre calls for the outdated GP funding formula to be replaced by a needs-based payment to better address health inequalities. 💷
Read here: www.nuffieldtrust.org.uk/resource/fai...
Read here: www.nuffieldtrust.org.uk/resource/fai...
Reposted by Sam Finnikin
I’ve heard about 2 ‘referral management’ services in the past week that are clearly designed to keep patients away from waiting lists. Problem is, the experience of the patients I’ve heard from has been appalling. Reminder: It is possible to provide *person centred care and reduce waiting lists*
November 26, 2024 at 2:42 PM
I’ve heard about 2 ‘referral management’ services in the past week that are clearly designed to keep patients away from waiting lists. Problem is, the experience of the patients I’ve heard from has been appalling. Reminder: It is possible to provide *person centred care and reduce waiting lists*
This is a great paper, thanks for posting Tom.
It's not good enough for risk prediction tools to be accurate. We must demonstrate that their use is clinically useful and cost-effective before adoption.
It's not good enough for risk prediction tools to be accurate. We must demonstrate that their use is clinically useful and cost-effective before adoption.
Is targeted prevention likely to be cost effective?
It depends on three things:
1) How accurate is the targeting? (PPV)
2) How effective is the intervention? (NNT)
3) How much does a prevented event save? (-£)
4) How much does the intervention cost? (+£)
link.springer.com/article/10.1...
It depends on three things:
1) How accurate is the targeting? (PPV)
2) How effective is the intervention? (NNT)
3) How much does a prevented event save? (-£)
4) How much does the intervention cost? (+£)
link.springer.com/article/10.1...
IAPN: a simple framework for evaluating whether a population-based risk stratification tool will be cost-effective before implementation - Cost Effectiveness and Resource Allocation
Risk prediction tools are widely used in healthcare to identify individuals at high risk of adverse events who may benefit from proactive interventions. Traditionally, these tools are evaluated primar...
link.springer.com
December 6, 2024 at 8:35 AM
This is a great paper, thanks for posting Tom.
It's not good enough for risk prediction tools to be accurate. We must demonstrate that their use is clinically useful and cost-effective before adoption.
It's not good enough for risk prediction tools to be accurate. We must demonstrate that their use is clinically useful and cost-effective before adoption.
Love how Bluesky put these two posts together for me…..
Do read @ritamc.bsky.social excellent thread on why private primary care is not the answer.
Do read @ritamc.bsky.social excellent thread on why private primary care is not the answer.
December 4, 2024 at 10:06 PM
Love how Bluesky put these two posts together for me…..
Do read @ritamc.bsky.social excellent thread on why private primary care is not the answer.
Do read @ritamc.bsky.social excellent thread on why private primary care is not the answer.
Reposted by Sam Finnikin
@bjgp.bsky.social @rcgp.bsky.social read Iona Heath’s BJGP Editorial from 20yrs ago on pitfalls of #physicianassociates & particular issues for deprived areas & inverse care pmc.ncbi.nlm.nih.gov/articles/PMC... we need more GPs particularly in deprived areas!
December 3, 2024 at 8:05 PM
@bjgp.bsky.social @rcgp.bsky.social read Iona Heath’s BJGP Editorial from 20yrs ago on pitfalls of #physicianassociates & particular issues for deprived areas & inverse care pmc.ncbi.nlm.nih.gov/articles/PMC... we need more GPs particularly in deprived areas!
Reposted by Sam Finnikin
Cautionary tale about potential harms of guideline-based care (more harm with intervention to treat to guideline)
… OR …
Shining a(nother) light on the magic sauce of longitudinal primary care (versus focused pursuit of surrogate measure targets)
🤨
www.nejm.org/doi/full/10....
… OR …
Shining a(nother) light on the magic sauce of longitudinal primary care (versus focused pursuit of surrogate measure targets)
🤨
www.nejm.org/doi/full/10....
Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease | NEJM
Despite the availability of effective therapies for patients with chronic kidney disease,
type 2 diabetes, and hypertension (the kidney-dysfunction triad), the results of large-scale
trials examini...
www.nejm.org
December 3, 2024 at 2:25 AM
Cautionary tale about potential harms of guideline-based care (more harm with intervention to treat to guideline)
… OR …
Shining a(nother) light on the magic sauce of longitudinal primary care (versus focused pursuit of surrogate measure targets)
🤨
www.nejm.org/doi/full/10....
… OR …
Shining a(nother) light on the magic sauce of longitudinal primary care (versus focused pursuit of surrogate measure targets)
🤨
www.nejm.org/doi/full/10....
Reposted by Sam Finnikin
@clarepharmacy.bsky.social might say "A bit blokey " but one of our most edgy and thought provoking podcasts re NHS systems #pharmsky
Have you caught up with our latest episode yet?! Professor John Seddon of Vanguard and Failure Demand joins us for a provocative conversation about the future of the NHS - and more importantly - how to save it! www.theauralapothecary.com/aural-apothe...
November 30, 2024 at 8:27 AM
@clarepharmacy.bsky.social might say "A bit blokey " but one of our most edgy and thought provoking podcasts re NHS systems #pharmsky