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International Primary Care Association

Clinical Focus Volume 3 N2

IPCA Admin

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The finding of a thyroid nodule raises concern of malignant disease. Thyroid nodules are common but thyroid cancer is rare. The incidence of thyroid cancer in those with clinical features strongly suggestive of malignancy is high but the majority of patients do not have these features. Appropriate investigation will identify the more common benign nodules, avoiding unnecessary testing and surgical treatment in the majority. All patients with thyroid nodules require biochemical assessment to exclude hyper or hypothyroidism and overt thyroid dysfunction effectively rules our malignancy. Fine needle aspiration cytology (FNAC) is increasingly used as first line investigation of thyroid nodules. Fine needle aspiration cytology and a thyroid function test are cornerstones of investigation.


This study reviews how primary care trusts (PCTs) are supporting redesign of care pathways from primary care into consultant outpatient services Footnote 1. Its aim is to help PCT managers understand:

  • Which organisational and contextual factors have particular impact on a PCT’s ability to progress successful redesign programmes
  • How some PCTs have overcome local barriers to implement new care pathways.

Redesign helps to ensure that patients are treated by the most appropriate healthcare professional in the most appropriate location. This improves patients’ experiences (for example, by reducing waiting times), helps to manage demand for acute care and introduces a greater range of providers,

Over the last few months there have been significant changes to the expectations and requirements for General Practitioners in several areas of their practice. In particular, the New GMS Contract aims at increasing the quality of care and is measured with quality markers. If the quality markers are achieved, GPs are awarded points, which are then translated into increased practice profit. However, it is all too easy to fall into the trap of fulfilling the criteria without drawing any conclusions or acting upon them.


This article is a management review of the challenges facing Primary Care Trusts with the introduction of Choice at point of referral in December 2005. Practitioners with Special Interests could be key to developing robust primary care services. They have unique skills in primary care and in their specialist area which could be utilised to develop locally provided services with rapid access that prevent hospital appointments. If a hospital appointment is required, they are excellently placed to provide expert information to patients concerning their choices, ensuring that the choice offered is clinically appropriate for that patient. Accurate data on referral levels in all specialties is essential to ensure the correct level of capacity is purchased by PCTs with appropriate secondary care providers. This article recommends the use of a Referral Monitoring Centre to assess the capacity needs now, to provide accurate data collection.


Most of us consider Negotiation as something that happens only when buying a house or a new car: one argues in a “traditional” way offering less than one is willing to pay, trading concessions for concessions - grudgingly, in the hope of shaking hands on a reasonable price in the end. When the deal is done, the parties involved rarely feel happy.

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