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International Primary Care Association

Clinical Focus Volume 1 N3

Volume 1 Issue 3 - 2006


An abnormal mass in the neck is an important clinical finding in all age groups. The challenge is to differentiate trivial disease with a self limiting natural history from more serious pathology. The aim of this article is to provide a structure in order to make the correct diagnosis in patients presenting with a neck lump. The relevant anatomy will be described as well as some important principles to aid in diagnosis. Common causes of neck lumps and their management will then be described.


Epsom Downs Integrated Care Services (EDICS) is one of the first and largest groups in the UK in which GPs have used SPMS (specialist personal medical services) to contract for out-patient care for their patients. One of the tasks has been to develop the role of the GPSI at the gateway between primary, intermediate and secondary care. This article discusses how EDICS GPSIs are not simply service providers, but how they take on an enhanced role in demand management, service development, and continuing medical education.

Throughout my career as an optometrist, I often wondered whether I could possibly go back and do medicine and go into ophthalmology. It was about 3 years ago that I was reading about medical schools taking 2 years off the training for postgraduates. I wondered if this would be my last chance to do what I always wanted. I went down to St George`s Hospital at Tooting to attend an open day and looked at the course. At the same time a circular from Rila came through the post advertising a Postgraduate Diploma in Ophthalmology that was going to be available later in the autumn of that year. I went to see a local Consultant ophthalmologist, at Stoke Mandeville Hospital, and discussed the Rila programme with him. He felt that despite the shortened medical model it would still be a long slog before I could enter ophthalmology and felt that the postgraduate diploma in ophthalmology was ideal. The climate was also changing as regards to optometrists being allowed to do a lot more in hospital based clinics commensurate with their clinical skills and expertise.


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