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International Primary Care Association

Clinical Focus Volume 3 N1


The medical profession is rarely out of the media. The government over the last few years has used the re-negotiated GP contract, to which they were signatories as a mechanism for driving future policy. The matter at present being that, GPs are now very well paid and therefore additional work and services can be implemented with or without agreement. This has led to the stand off on extended hours for GP surgeries, with the BMA essentially opposed to the terms on the table and the government indicating, no alternative option on implementation of the added services.

It is difficult to argue with the government as they seemed to have asked a question of the public, to which the answer would naturally be in the affirmative. The proposition to the public, paraphrased, “Would you like to see GP surgeries open at more convenient times such as evenings and weekends?” Who would not say yes! Nevertheless, my own non evidenced based straw poll i.e. talking to several colleagues indicate that the DNA rates for evenings and Saturday mornings are 30- 50%, when they provided such services previously. Many found it just was not cost effective and so discontinued the facility. The government’s approach appears to be based on poor understanding of primary care with a desire to display power or is it bullying, towards the medical profession. .

This issue of Clinical Focus highlights (Dr. Shankar et al) the much maligned area of health, “Public Health” and the potential role of GPwSIs in the specialty area. For strategic health planning and implementation, it is essential to have expertise that can address health issues on a population rather than an individual based concept. One of the alternative therapies, favourites of Prince Charles, have been visited by Dr Monella, who provides a primary care service in acupuncture. He shares his experience. .

The rarity of male breast cancer is known and the approach to its specific management is less likely to be based on sound evidence. Karen Tipples and Phillip Murray provide a succinct article indicating that many decisions regarding treatment are based on knowledge of female breast cancer. .

Dr Paul Steventon has provided us with the core features of “Managing Urticaria.” He gives a GPwSI in Dermatology perspective thus making the article a valuable contribution in GP education. .

The ageing population will inexorably alter the incidence of certain pathologies. Already primary care is seeing a shift in urological services. Some health providers are beginning to deliver the long term treatment of prostate cancer in the community. Dr. Saugata, GPwSI in Urology, has a tangential but highly educative and amusing look at Erectile Dysfunction. From WMD to ED in one article! Messrs Hemmerdinger and Wong have produced an excellent overview of “Age Related Mascular Degeneration.” The presenting symptoms are subtle but if picked up early a multitude of treatment modalities are available. It is also interesting to read the myriad of “Low Vision services”, available to improve patients' lives. .

Finally I would like to welcome Dr. Nazeer as an additional co-editor. Besides his GMS work he works in secondary care in both diabetes and A+E in University College Hospital, London. His expertise will enhance the editorial team and be reflected in the journal over the coming period. .

Editor in Chief
Professor Ram Dhillon

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