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A tumultuous year so far for UK generally and the NHS in particular. Against most of the predictions the EU referendum was a win for the exit camp. This will have major effects on healthcare delivery, both directly and indirectly.  

Through the clamour of misinformation the NHS was going to benefit from over £360 million a week. Now clearly a falsehood. The dire consequences of underfunding are coming home to roost with the Accident and Emergency department of Grantham and District Hospital closing its unit due to lack of staff. We are here because of juxtapositions of lack of resource, poor workforce planning and the |Brexit effect of warding off potential recruits from the EU and incumbents leaving for better opportunities. Claire Marks, President of the Royal College of Surgeons, also made the telling point on a Radio 4 interview, that extracting yet further spending cuts, which the government wants, is not avoiding the spend, merely postponing it. Theresa May, our Prime Minister, is now going to have to make the tough decisions on priorities for the country: NHS v HS2 (or even HS30) v Hinckley Nuclear plant v Trident v Extra runways at major airports...

Brexit will just compound the NHS problems, even if some of our national dailies have treated the exit decision as a positive. Already medical research is standing to lose ~ £800 million of EU funding. Grant applications with UK lead researchers have made the decision to front with non UK colleagues. The large percentage of existing EU researchers in the UK are concerned regarding their residency. Major medical trials, crossing EU borders, are likely to be effected and some may never materialize. The University of Kent who were negotiating with EU organisations for an EU Health Service University have pretty much ceased the dialogue. On goes the catalogue of problems this has created and will create for healthcare delivery. The similarities with the NHS are even starker. Decisions and policies made on high by politicians in the EU referendum and Senior Managers in the NHS usually throw an incendiary device into a system which the inmates are left to sort out.

Let’s get back to clinical medicine. The continued worry over antibiotic resistance and adverse effects is neatly encapsulated in Dancer’s article (p.62), but she also suggests ways we may be able to contain the problems that are emerging and which may very soon have dire consequences in our ability to combat infections. Middleton and Anakwe (p.73) provide an overview of common hand disorders and the role of primary care in management.

The ageing demographics has meant that patients with heart failure are becoming more prevalent and the resource burden has increased dramatically in managing the condition. Identifying the early symptoms of heart failure, before it requires hospital admission, is a key role for general practice. Amer and Rather (p.84) have outlined the full pathway of management. Rather, with his second paper in this issue, and with colleague Qureshi (p.100), has provided us with a slant on Parkinson’s disease which is NOT focusing on the motor abnormalities but the non-motor symptoms, which clinicians may well overlook and
patients not highlight.

Phillipa and her co-authors (p.113) have taken a non-formal approach to highlighting some key rheumatological conditions. They have addressed a number of disorders employing a case based discussion. I am sure you will enjoy the approach and learn how to better manage your patients. 

Do remember that for your appraisal and revalidation you could do a lot worse than attempt the CPD activity available on line for each of the contributions that will permit you to assess your knowledge base and skills.

Please email comments and suggestions to me.


Professor Ram Dhillon


Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: Clinical Focus Primary Care
Read 17072 times Last modified on Tuesday, 25 October 2016 16:35

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