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International Primary Care Association

Clinical Focus Volume 1 N3

IPCA Admin

IPCA Admin

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Point-of-care testing involves a range of tests within pathology and has been highlighted as an area of importance for service development. However, in moving testing away from the carefully managed environment of the central laboratory it is essential to ensure that quality of service is maintained. Provided this is achieved, Point-of-care testing has the potential to bring about improvements in clinical care.


All health systems are seeking ways of reconfiguring their services to provide care more effectively and efficiently. One option is to deliver services from general practitioners with a special interest. In the UK, this model is being developed across a number of specialities within the context of a NHS modernisation agenda. The objective of this paper is to describe the operation of an intermediate care headache and from a more general perspective, the problems of obtaining evidence of effectiveness and cost effectiveness in the area of intermediate care.


The spectrum of disease starts to change and disability rises after the age of 60 years. In old age the combination of multiple chronic pathology makes predicting the course of illness difficult. There are different patterns of disease presentation with somewhat altered responses to treatment. Elderly patients require comprehensive multidisciplinary assessment and access to rehabilitation services to help restore them to their maximum ability. As there has been a marked increase in the elderly population, elderly patients now constitute the bulk of workload in most specialities. This article is not intended to give a comprehensive description of all aspects of geriatric medicine but to raise awareness of commonly encountered clinical problems in old age.


Echocardiography plays a very important role in the management of patients with heart disease in primary and secondary care, but the direct echo services in primary care is scarce. One approach to improving this is to establish community echo services run by GPs after intensive and formal training. This is not a substitute for a full echo study provided by a cardiology department. Nevertheless community echocardiography can be extremely useful in many common cardiac conditions.

The latest Government’s primary care white paper ‘Our health, our care, our say: a new direction for community services’ shows further support for the development of Practitioners with special interests (PwSIs), practice-based commissioning and community hospitals. Yet issues of training, accreditation, continuing professional development and remuneration remain unclear. At an individual level, these areas are highly relevant and topical. Through these constantly changing NHS times, we hope to bring some clarity and guidance on these more practical matters, not only through this journal, but more so through the open forum on our website The Association of Practitioners with Special Interests (APWSI) is expanding steadily, and our 3rd annual conference "Enhancing the delivery of healthcare" is a further opportunity to tackle these hot topics in a more personal and interactive arena.

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