Background: Endometriosis affects approximately 10% of women, with well-documented delays between initial presentation with symptoms and diagnosis. In England, women typically seek help first in primary care, making this setting pivotal in women’s pathways to diagnosis and treatment. English General Practitioner (GP) perspectives on managing possible endometriosis have not been previously reported. Aim: To explore what GPs identify as important considerations when caring for women with symptoms that raise the possibility of endometriosis. Design and Setting: English primary care. Method: Semi-structured scenario-based telephone interviews with 42 GPs based around a fictional scenario of a woman presenting to primary care with symptoms suggesting possible endometriosis. Interviews were thematically coded and analysed. Results: Managing possible endometriosis in primary care brings challenges. While knowledge and awareness were pre-requisites for considering endometriosis, other important considerations were raised. Symptoms suggestive of endometriosis are non-specific, making endometriosis one possible consideration of many. GPs move through a diagnostic hierarchy to exclude sinister causes and utilise trials of treatment as both therapeutic interventions and diagnostic tools – processes which take time. An endometriosis label or diagnosis has advantages and risks. GPs reported sharing decisions about investigation and referral whilst holding women’s priorities as pivotal. These conversations were underpinned by their knowledge of uncertainties and unknowns, including the wide spectrum and unpredictability of endometriosis. Conclusion: GPs considerations are more complex than simply lacking awareness. The unknowns surrounding endometriosis matter to GPs. Further research and tailored resources for primary care, where women present with undifferentiated symptoms, are needed.

Social media can be used to both enhance and diminish students’ experiences of university and its influence is strong for lesbian, gay, bisexual, transgender, queer and other non-heterosexual and gender-diverse (LGBTQ+) people facing stigma and discrimination. Students may feel exposed when identifying as LGBTQ+, particularly while transitioning to university life. In this study, we used theories of performance and digital personhood to explore how LGBTQ+ students use social media for identity management. We report a thematic analysis of 16 interviews. Four themes were generated from the data, showing that students use social media to explore, conceal, protect and express their identities. We found that different social media provide stages where LGBTQ+ identities are constrained by different and distinctive social factors. Thus, LGBTQ+ students’ online identities are multiple, situated and bound to specific platforms, with some alternatives to Facebook offering a space where students may feel more comfortable performing their authentic selves.

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Summary Two‐thirds of UK adults do not have an up‐to‐date weight record in primary care. Some studies suggest that doctors do not raise the topic of weight management for fear of causing embarrassment or offence, or are doubtful whether people will make changes. However, for people with weight‐related long‐term conditions, conversations with general practitioners (GPs) can be crucial. Our study explores how people with long‐term conditions associated with overweight recall and interpret conversations about weight in British primary care. An experienced qualitative researcher interviewed 41 people aged <42 years with long‐term conditions associated with overweight. A maximum variation sample was sought, and transcribed interviews were analysed thematically. We revealed that patients with weight‐related long‐term conditions have different experiences and expectations about the role of GPs in supporting weight management. If a GP did not raise weight management in the context of the long‐term condition patients formed the impression that their overweight was not seen as “doctorable” that is, as an appropriate topic for the consultation, rather than a personal or “lifestyle” concern. This was explained in multiple ways, which are captured in two themes; perceiving weight as “doctorable”; and weight doctoring in primary care. The findings highlight the need for increased attention on weight‐related long‐term conditions in primary care. Interventions from GPs would be welcome if conducted in a sensitive, non‐judgmental manner and based on sound evidence about what works.

Background Most adults fail to achieve remission from common mental health conditions based on pharmacological treatment in primary care alone. There is no data synthesising the reasons. This review addresses this gap through a systematic review and thematic synthesis to understand adults’ experiences using primary care for treatment-resistant mental health conditions (TRMHCs). We use the results to produce patient-driven recommendations for better support in primary care. Methods Eight databases were searched from inception to December 2020 for qualitative studies reporting research on people’s experience with TRMHCs in primary care. We included the following common mental health conditions defined by NICE: anxiety, depression, panic disorder, post-traumatic stress, and obsessive-compulsive disorder. Two reviewers independently screened studies. Eligible studies were analysed using an aggregative thematic synthesis. Results Eleven studies of 4456 were eligible. From these eleven studies, 4 descriptive themes were developed to describe a cycle of care that people with TRMHCs experienced in primary care. In the first stage, people preferred to self-manage their mental health and reported barriers that prevented them from seeing a GP (e.g., stigma). People felt it necessary to see their GP only when reaching a crisis point. In the second stage, people were usually prescribed antidepressants, but were sceptical about any benefits they had to their mental health. In the third stage, people self-managed their mental health (e.g., by adjusting antidepressant dosage). The fourth stage described the reoccurrence of mental health and need to see a GP again. The high-order theme, ‘breaking the cycle,’ described how this cycle could be broken (e.g., continuity of care). Conclusions People with TRMHCs and GPs could break the cycle of care by having a conversation about what to do when antidepressants fail to work. This conversation could include replacing antidepressants with psychological interventions like talking therapy or mindfulness.