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International Primary Care Association
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‘Legal highs’ are more properly known as Novel Psychoactive Substances (NPS): in the UK, following legislative changes in 2016, all current and future such compounds are proscribed. There are over 560 NPS, and their consumption is common. Most individuals who take NPS, or any other recreational drugs, do not develop significant physical or mental health problems, but a considerable number will do so, and many will first present to primary care.

Despite their large number, NPS can be broken down and considered under four main classes: ‘stimulants’, which are drugs like cocaine, ecstasy, and amphetamine; ‘cannabinoids’, which are drugs like cannabis; ‘depressants’ that are opioids and benzodiazepines; and ‘hallucinogens’ like ketamine and LSD. However, the wide range of NPS means that sometimes the novel drugs are more dangerous, and NPS must not be considered as ‘safer’ alternatives to more established compounds. Furthermore, NPS are available in a wider range of formulations, and GPs must enquire as to how the drug is consumed: whether swallowed, snorted, smoked, or injected, with the risk profile changing accordingly.

Good assessment requires a non-judgmental and empathic approach, and should aim to classify the drug type and method of consumption, acute and chronic physical and mental health harms, and any need and patient desire to have further care from specialist services. Acutely, benzodiazepines and antipsychotics may be prescribed for very agitated patients. Autonomic instability, hyperthermia, and altered or loss of consciousness warrant urgent transfer to the Emergency Department.

Hypertension is the persistence of elevated blood pressure - one of the most familiar medical conditions encountered in family practice. Hypertension is asymptomatic, and its management can be arduous, which is unfortunate given that its presence represents a dangerously potent herald of significant morbidity and mortality.

The Female lower urinary tract symptoms (FLUTS) are a collection of symptoms akin to the wellknown lower urinary tract symptoms (LUTS) in male counterparts. It is a common presentation in primary care consultations, particularly in women of middle to late age. Awareness of risk factors and actively looking out for these cases may be worthwhile particularly as patients may not be very forthcoming with this problem. Careful history taking, examination and assessment of its impact on quality of life (QOL) are of paramount importance. There is a need to carry out holistic assessment of these patients prior to offering management plan, which can include self-help measures, behavioural treatment, medications and surgical treatment.

This article illustrates the magnitude of the problem and will assist clinicians in primary care to identify, diagnose and manage patients with FLUTS in an evidence-based manner.

Increasing levels of antimicrobial resistance are currently a big problem in the management of Gram negative infections caused by enterobacteriaceae. This article reviews resistance mechanisms, focusing on a management approach relevant to primary care.

It has been an odd summer, and autumn has already and will usher in further calamities. On the home front, the Brexit debate has moved from the extreme hardline exit to a softer approach now that that the consequences of the simple IN or OUT vote have been gradually unveiled by a much-divided government and a slightly less divided opposition. I note a that May et al have subtly indicated changes in their stance, with a wish to continue membership of Research organisations (UK has awards of ~ 1 billion Euros per annum from the EU), Security organisations, there has been a shift on immigration………the list goes on. Strangely, as far as the NHS is concerned, NHS England are looking to attract 1000s of doctors, from the EU, to fill the deficit in GPs! I am not entirely certain they will be able to fulfil the need, as EU healthcare professionals are leaving the UK, rather than flocking to it. We shall probably have to turn to the Commonwealth, India, Australia, Canada….to fill the gaps left and additionally to make up deficits from poor workforce planning.  

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