More crises in the NHS. General Practice is being overwhelmed and recruitment has slowed and so we have returned to enticing doctors from abroad. It is astonishing that with all the resources allocated to “Workforce Planning”, both financial and human resource, we continue to lurch from feast to famine in medical manpower! I recall the tiered lecture rooms in the Middlesex Hospital Medical School, London there was a row of chairs with easels to accommodate the extra places for Medical students as the planners had grossly underestimated UK’s requirements. The politicians closed the Medical School and where the Middlesex Hospital once proudly served the populace, is a building of apartments that only foreign investors can afford.
Many years ago there were educational leads in local healthcare economies with ring fenced budgets to ensure appropriate use of funds. It worked very well, so it was dismantled with the education budget being included in generic funds. Surprise surprise, the money just vanished. John Major’s “Investors in People”, you must have a plaque somewhere in your hospital/surgery, and most subsequent initiatives were hot air laden with false promises but made brilliant sound bites!
Lo and behold, we have now reached the start point of the full circle. All that was archaic and inefficient; educational leads, ring fenced budgets, community hospitals, primary care……..is suddenly the new mantra. Our politicians are mirror images of NHS managers: reinventing ideologies at breakneck speed, ditching them for the next untried idea, chasing voters and short time gains and targets.
Let us try and aspire to clinical excellence, not only is this good for our patients and the community, while indulging in the satisfaction of individuals who, “Can make a positive difference.” The recognition that Attention Deficit Hyperactivity Disorder (Cubbin and Jeffs p.50) does NOT “only rarely” continue into adult life will permit us to diagnose and manage these patients better. Anish Bahra (p.60) provides an insight into the secondary headaches, much rarer than the primary variety, but can be a conundrum. She very neatly encapsulates the dilemmas and points to pathways to deal with common presenting symptom.
Hepatitis C Virus (HCV) is eminently treatable and potentially curable state Thiagarajan and Ryder (p.70), but the “at risk patient”, is frequently missed in primary care. Perhaps that is why HCV is a major cause of cirrhosis and the most common indication for liver transplantation in Europe. We should be able to improve the depressing statistics and make a difference.
The male snorer, the butt of endless jokes, may be displaying the noise of the more serious underlying, “Obstructive Sleep Apnoea (OSA),” (Prudon & West p.80). What, with figures of prevalence of OSA in 2% females and 4% males aged 30-60, this is a major public health issue as it is associated with cardiovascular disease, impairment of cognitive function, insulin resistance………The authors provide respite as the vast majority of OSA suffers can be picked up, in primary care, by employing the STOP BANG triage questionnaire, consisiting of 8 simple questions. Management will make a difference to the patient and the sleeping partner.
Rudenko (p.90) has very succinctly provided us with the cause, diagnosis and management of the epidemic of Asthma and Allergic rhino-conjunctivitis. He is an advocate of immunotherapy for allergic rhinitis, a treatment that fell into disrepute, unfairly, in the UK some 30-35 years ago, but has been shown to change the course of the disease. Please participate in the “Verifiable CPD activity”, as it is important for appraisal and revalidation. Do drop me an email if you have any suggestions and ideas for future editorial content.
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