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The deed is done. Brexit is happening. We shall see what it brings to the NHS, a worsening of frontline medical and non-medical staff by all accounts. A trickle of exits of EU citizens may turn to a deluge if the issue of retaining citizenship is not resolved, early on in the negotiations. The worry is that the UK government may be relying on recruiting from outside the EU, such traditional heartlands as India, Nigeria and other Commonwealth of Nations. I am not sure if this will be easy as the laws on immigration and rights have so parred the advantages that there is unlikely to be a rush of healthcare staff wishing to come to the UK. The double whammy for politicians is that increasing numbers of staff, particularly in primary care, are choosing to retire early, work part time or simply have a career change. Plugging this gap, with the decision for additional places in medical school, will take over a decade for the effect to show. Indeed, the last round of undergraduate medical school places were unfilled and had to be offered in clearing. I cannot remember this happening in my working lifetime, 39 years. Jam tomorrow then!  

Cynicism is rife with most of the government initiatives. STPs, for example, are designed to make the health service more efficient, provide better care and rationalise services. For many it is a euphemism for saving money and cutting costs i.e. reducing services. The government still has not explained where the resource for implementing STPs, worthy they may be, will be coming from. No new money is forthcoming, so the assumption is it will be generated by internal service reduction, as efficiency savings have now gnawed on the bones of the NHS. No waste left to trim. All this may be irrelevant as we could be in the midst of a nuclear war as one testosterone man, Donald Trump, confronts his doppelganger alpha male, Kim Jong-Un, in a demonstration of, “anything you can do I can do better”. Mind you Trump does so many U turns that he is positively spinning i.e. Obamacare, Mexican Wall, Obsolete NATO……….so maybe he will resist the urge to teach the Korean leader a lesson.

The world keeps turning and people keep falling ill despite the games played by politicians. Healthcare staff, who have little control over most events, can still provide comfort and hope to those with illness. This may have huge non-monetary benefits to the healthcare giver. The death of Emma Morano, who, until earlier this year, was the oldest living person, aged 117, prompted a search for the factors in longevity. One I came across was that selflessness is key to a long life. For Morano it must have been ultruism and the 2 raw eggs eaten each day for the previous 90 years.

This issue has a piece on Colorectal cancer (p.74, Thrumurthy et al) and an interesting resume on Poisoning, and the role of primary care (p.89 by Fok et al). We hear a lot about mental health in adults, but little about children suffering the same. Burden, p.101, redresses this imbalance with a focus on Depression in children and adolescents. GPs must see many patients with possible hip symptoms. Ranjit et al, p.110, have provided a useful “What you need to know”, overview. Perianal dermatoses, p.121, by Abu-Asi et al, is not glamorous, but highlights an important clinical area, where diagnoses can be made readily in the community and the patient managed, therefore, appropriately. Finally, Han et al, p.138, have put together a succinct and pictorial piece on Red flags in eye disease.

Do remember that for your appraisal and revalidation, verifiable CPD activity is available on line for each of the contributions, which permits you to assess your knowledge base and skills.

Please email comments and suggestions to me.

Professor Ram Dhillon

Editor

Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: Clinical Focus Primary Care
Read 847 times Last modified on Friday, 28 April 2017 08:02

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