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International Primary Care Association

Volume 10 Issue 1 - 2016


Urological conditions can often be a source of considerable anxiety for both parent and child but with an understanding of normal anatomy and basic conditions it is possible to manage many presentations in the community and provide reassurance to families.



Paediatric sepsis is an important cause of morbidity and mortality in children. However, in a primary care setting it remains uncommon. This is a review of the current understanding of paediatric sepsis together with evidence-based advice about its recognition and management in primary care.



The incidence of self-harm is increasing in the UK. It is the single best predictor of completed suicide and is associated with poor outcomes in terms of emotional wellbeing and educational attainment. The majority of patients do not present to medical services after an episode of self-harm and so GPs play an important role in identifying the problem, reducing stigma and providing support.


Self-harm is associated with a broad range of risk factors related to emotional distress rather than severe mental illness. It is commonly associated with misuse of alcohol and other substances. Other important risk factors are adverse life events such as unemployment and relationship difficulties, as well as a history of current or past abuse or institutional care. In young people precipitating factors can include arguments with parents and stressors at school such as exam pressures, bullying or cyber bullying.


Self-harm is stigmatised by the general public and medical professionals, so there is a need to approach the subject with sensitivity, respect and acceptance. Self-harm is a behaviour, rather than a diagnosis in itself. It can be seen as a symptom of an underlying mental or personal difficulty, or serve a function for the patient; exploring these reasons can guide management, which focuses on the underlying difficulties. Actively involve the patient in the management plan, asking about their preferences and previous experiences of treatment. High risk patients with a severe mental illness or active suicidal thoughts should be urgently referred on to mental health services for further assessment. Patients at low risk may be supported in primary care, and those in between can be referred to non-urgent mental health or social services, or a 3rd party organisation.

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