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International Primary Care Association

Clinical Focus Volume 3 N1

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Heart failure due to left ventricular systolic dysfunction (LVSD) carries a high morbidity and mortality. LVSD merits rapid, accurate diagnosis in order to initiate evidence based management strategies. The Darlington heart failure services model, part of the South Durham Heart Failure Network, was devised to overcome barriers to accurate diagnosis and effective management of heart failure. It involves rapid diagnosis of LVSD and ongoing heart failure management. A weekly one-stop diagnostic clinic, run by a GP specialist and a heart failure nurse, is jointly funded by the PCT and the NHS Trust. If LVSD is confirmed, a management plan is formulated which includes patient education and initiation of evidencebased therapy. The heart failure nursing service is invaluable in bridging the gap between primary and secondary care. Local guidelines, together with continuing education of GPs and practice nurses, and the new GMS contract, should further increase the uptake of evidence-based therapies at target doses.


The diagnosis and assessment of patients with acute anterior uveitis (AAU) is difficult in primary care. However, non-specialist examination techniques such as the evaluation of the patterns of conjunctival injection and the pupil reaction, as well as eliciting pain by the consensual light reflex and the finger to nose convergence test serve to distinguish the disease from other causes of a red eye. This brief review summarises this evaluation as well as providing a differential diagnosis of the red eye.

‘Navigating the stormy NHSeas’ was the title for this year’s CME ENT update conference in London. Traditionally aimed at a secondary care audience, I was interested to see a significant proportion of primary care issues on the agenda. Practice based commissioning in particular, remains a hot topic, and one that many consultant colleagues are struggling to understand and accept. In certain parts of the country, specialist services, originally commissioned by the Primary Care Trusts (PCTs), are now being handed over to local groups of GP practices to manage and deal with. In an attempt to develop new and more patient centred services, the Department of Health believe that primary care practitioners are better placed to do this. It is not surprising that general practitioners with special interests have a key role to play

Throughout my career as an optometrist, I often wondered whether I could possibly go back and do medicine and go into ophthalmology. It was about 3 years ago that I was reading about medical schools taking 2 years off the training for postgraduates. I wondered if this would be my last chance to do what I always wanted. I went down to St George`s Hospital at Tooting to attend an open day and looked at the course. At the same time a circular from Rila came through the post advertising a Postgraduate Diploma in Ophthalmology that was going to be available later in the autumn of that year. I went to see a local Consultant ophthalmologist, at Stoke Mandeville Hospital, and discussed the Rila programme with him. He felt that despite the shortened medical model it would still be a long slog before I could enter ophthalmology and felt that the postgraduate diploma in ophthalmology was ideal. The climate was also changing as regards to optometrists being allowed to do a lot more in hospital based clinics commensurate with their clinical skills and expertise.


Epsom Downs Integrated Care Services (EDICS) is one of the first and largest groups in the UK in which GPs have used SPMS (specialist personal medical services) to contract for out-patient care for their patients. One of the tasks has been to develop the role of the GPSI at the gateway between primary, intermediate and secondary care. This article discusses how EDICS GPSIs are not simply service providers, but how they take on an enhanced role in demand management, service development, and continuing medical education.

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