Brief conversations in primary care: an opportunity to boost health

The NIHR recently published a Collection, focusing on conversations in primary care.  Long-standing guidance encourages healthcare professionals to offer opportunistic advice, in as little as 30 seconds. But research suggests that these conversations often do not happen. Tackling sensitive issues can be challenging and might require training. Primary care staff may fear that the discussion could be time-consuming, and could upset patients. They may believe that patients are not open to advice. However, the briefest of conversations can make a difference and primary care is the ideal place to offer lifestyle and mental health advice. 

Public health issues such as obesity, smoking, alcohol, and mental health are complex and affect a significant proportion of the population. Primary care consultations - often for unrelated reasons - can provide a golden opportunity to address such issues.  Research funded by the NIHR provides insights into patients’ views on GP advice, and reveals how to optimise these conversations. It shows that people welcome advice on weight, alcohol, and smoking. They prefer tailored, individualised information. 

Two studies highlighted in the Collection were funded by the NIHR School for Primary Care Research. 

• A study, by Dr Amy O’Donnell et al, showed that conversations on alcohol should explore people’s reasons for drinking, build on the strategies they already use to limit it, and include information on the long-term health risks. The full paper ‘Patients’ experiences of alcohol screening and advice in primary care: a qualitative study’ can be read here.  
• A study, by Dr Charlotte Albury et al, found that people with obesity  are more likely to accept a referral to a weight management programme if healthcare staff use key phrases early in the conversation. The briefest description of a programme - that it is ‘like Slimming World’, it is local and free of charge for 12 sessions - can result in more acceptances. The full paper ‘Discussing weight loss opportunistically and effectively in family practice: a qualitative study of clinical interactions using conversation analysis in UK family practice’ can be read here. 

GPs and nurses can be reassured that individuals value their advice. Personalised information, inclusion of key details early on, and open-ended questions can make these brief exchanges even more effective. 

“I was surprised that there is any doubt about whether or not healthcare professionals should have these conversations. They definitely should. Primary care is the perfect place for this.’’ - Fabiana Mariscotti, public contributor 

“Every consultation is an opportunity. Whilst we should deal with the presenting problem, it is important to also consider the patient’s other problems and take the opportunity to offer advice about how to stay well.’’  - Carolyn Chew-Graham, GP 

This Collection, reassures healthcare professionals that no topic need be a no-go zone. Brief conversations have great potential to improve health and wellbeing.