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International Primary Care Association

Clinical Focus Volume 3 N2

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Phew! Andrew Lansley and the coalition must be relieved that the Health and Social Care Bill has finally been passed. It seems have had more alterations than a wedding suit and now one only hopes it fits the purpose. Opposition continued to the bitter end. Members of the Royal College of Surgeons, managed to muster the minimum number of sponsors to call an EGM to debate the RCS’s approach to the legislation. In the event the debate voted in favour of “Critical participation”, rather than aligning to several other august professional bodies who took a stance of “Open opposition”. The Bill has come to pass, which frankly was inevitable.


This paper represents personal reflections on the evolution of urology service provision over the past 30 years and offers a possible scenario for such provision in the future.

I qualified forty years ago; those were the days when consultants were revered and their senior registrars worked hard to ensure that their masters were never disturbed out of hours; now it seems to be the consultants who work hard so that the ‘juniors’ can stay in bed! There were plenty of ‘Sir Lancelot Spratt’ (the senior surgeon in Richard Gordon’s film ‘Doctor in the House’1) characters about; one of whom undertook an open prostatectomy on my father. A few days later, when he found out that I was due to start at medical school later that year, I was summoned to watch him operate. After removing a kidney and leaving his senior registrar to ‘make good and close’, he took me into the senior surgeon’s sitting room and gave me a few pointers for the future. The most memorable ‘tip’ was that as soon as I had a consultant job I should buy a Rolls Royce car. “Borrow the money if you have to” he said but remember you are in the only job in which you will be respected more for it… and you can double your fees straight away!


This article discusses syncope, epileptic and febrile seizures. A careful history will determine whether an attack is provoked or unprovoked, facilitating further evaluation to establish diagnosis and management. It is important always to exclude acute symptomatic causes of seizures and syncope. The majority of children who experience syncope, febrile seizure or a single epileptic seizure will not have epilepsy.


Full assessment of the individual with genital ulceration should include a sexual history and specialised investigations. Infective and malignant causes need to be excluded before concluding an inflammatory origin. A multidisciplinary approach is often indicated.


Type 2 diabetes is becoming more common, primarily due to increasing levels of obesity in our society. It is also being diagnosed more frequently in young people, so it is now much more often seen in women of reproductive age. Given that people with Type 2 diabetes are now typically managed in primary care, it is important for primary care teams to understand the issues around pre-existing diabetes and pregnancy. For similar reasons, gestational diabetes is also much more common than it used to be and there are now internationally agreed criteria for diagnosis and a greater consensus in the principles of management.

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