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International Primary Care Association

Clinical Focus Volume 3 N2

Volume 3 Issue 2 - 2008

General Practice! Is its importance finally being recognised? Our political masters, despite the media rhetoric, clearly understand that healthcare standards can be raised and cost effectiveness more easily attained in primary care. Hence, the multiplicity of initiatives to change the direction of the NHS e.g. Treatment Closer to Home, Practice Based Commissioning, and even polyclinics! This wish list is unlikely to have an impact, short or long term, unless sufficient attention and resources are directed to providing the requisite clinical skills to those at the frontline.


Primary hyperparathyroidism and malignancy are the most common causes of hypercalcaemia. Parathyroid hormone measurement is fundamental in patient management. Symptomatic hypercalcaemia is relatively uncommon and will involve patient hospitalisation and subsequent treatment. Asymptomatic hypercalcaemia is increasingly recognised following introduction of multichannel biochemical analysis and, depending on aetiology and patient profile, is often managed in primary care.



To compare the referral patterns and clinical management of patients seen by GPwSIs with patients seen in traditional hospital ENT clinics.


A retrospective analysis of data from the clinical notes of 337 patients seen by GPwSIs in a primary care trust compared to a randomly selected sample from a neighbouring primary care trust seen by consultants or specialist registrars in hospital.


ENT clinics run by GPwSIs in ENT in a community intermediate treatment and diagnostic centre and traditional ENT outpatients clinics run by consultants from a teaching hospital secondary care trust.


337 patients from Bradford South & West PCT seen by GPwSIs and 338 patients from Bradford North Primary Care Trust seen by either a consultant or specialist registrar.

Main Outcome Measures:

Referral rates, clinical presentation and subsequent management of patients.


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