Volume 3 Issue 2 - 2008 http://www.ipcauk.org Mon, 17 Dec 2018 14:21:26 +0000 Joomla! - Open Source Content Management en-gb Editorial http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/75-editorial http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/75-editorial

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.

Too often the desire outstrips the means, which leads to further restructuring and more policy initiatives. The ultimate is a complete lack of focus and direction with resources channelled into “Change Management” rather than delivery of care. Perhaps we should ponder where all the extra monies pumped into the NHS over the last 10 years, by labour/Gordon Brown, actually ended up. A perspective to mull over is the fact that the UK spends more on healthcare than all the nations of Africa aggregated. Our Prime Minister is under personal and economic pressure so I await another NHS policy statement, which will lurch us into yet another reorganisation. The maelstrom of change will continue but we have to deal with the here and now: the patient sitting in the consultation room. The array of conditions seen in primary care are protean and we have a range of articles in this issue to reflect this. The rarity of hypercalcaemia should not result in a panic as Drs Munigoti and Jones have provided an elegant and easily digestible review. My friend Dr Rout, a GP with a Special Interest (GPwSI) in ENT lays to rest the oft quoted myth that such GPs provide an inferior quality of service. You may usefully quote this to managers who are being obstructive in developing such services. Depression is so commonly seen in primary care that there is a risk of becoming blasé but Drs Emad and Gopal provide a timely treatise of the condition and the seriousness with which it should be approached. The media is rife with features on “Chronic Fatigue Syndrome”, and GPs are frequently ill-equipped to deal with it. After reading the article by Drs Williams-Watson and Richards the apprehension on encountering a patient with depression will be significantly reduced. Finally, I should like to invite the readership to submit contributions which would be of interest to the delivery of care in the community. These can be review articles or case reports. Comments/letters on editorial content would be very welcome. I am always on hand if you wish to discuss your potential submission. Do drop me an email.

Editor in Chief
Professor Ram Dhillon

admin@ipcauk.org (IPCA Admin) Volume 3 Issue 2 - 2008 Fri, 02 Mar 2012 12:46:32 +0000
Management of Hypercalcaemia http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/76-management-of-hypercalcaemia http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/76-management-of-hypercalcaemia


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.

admin@ipcauk.org (IPCA Admin) Volume 3 Issue 2 - 2008 Fri, 02 Mar 2012 12:48:13 +0000
Can Specialist General Practitioners provide an alternative to ENT specialists? A comparison of referrals and clinical management of patients between hospital and intermediate care clinics http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/77-can-specialist-general-practitioners-provide-an-alternative-to-ent-specialists-a-comparison-of-referrals-and-clinical-management-of-patients-between-hospital-and-intermediate-care-clinics http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/77-can-specialist-general-practitioners-provide-an-alternative-to-ent-specialists-a-comparison-of-referrals-and-clinical-management-of-patients-between-hospital-and-intermediate-care-clinics



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.

admin@ipcauk.org (IPCA Admin) Volume 3 Issue 2 - 2008 Fri, 02 Mar 2012 12:49:55 +0000
Management of depression in primary care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/78-management-of-depression-in-primary-care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/78-management-of-depression-in-primary-care


Depression is a very common disorder, with a 5–10% prevalence in primary care settings.1 It has been estimated (by the World Health Organisation) that by the year 2020, depression will be the second most common cause of disability in the developed world, and the number one cause in the developing world.2 Women are approximately twice as likely as men to experience a depressive episode within a lifetime and the lifetime risk is 15% overall.3 Not only do depressive disorders have significant potential morbidity and mortality – the death rate may be as high as 15% - but they also contribute to increased mortality and morbidity when associated with other physical disorders.

With this is in mind, it is of some concern that up to half of the patients with a major depressive illness are not diagnosed and those who are diagnosed are often not adequately treated.4 Most depressive states are at the mild to moderate end of the spectrum and are managed mainly in primary care. In fact, 80% of people identified as having depression are managed entirely in a primary care setting.

admin@ipcauk.org (IPCA Admin) Volume 3 Issue 2 - 2008 Fri, 02 Mar 2012 12:55:19 +0000
Chronic Fatigue Syndrome (CFS) http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/79-chronic-fatigue-syndrome-cfs http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-3-n2/item/79-chronic-fatigue-syndrome-cfs


Chronic Fatigue Syndrome (CFS) is a debilitating disease with predominant symptoms being severe disabling fatigue (unrelieved by rest); unrefreshing sleep; widespread pains and neurological problems. Despite its official recognition by the Chief Medical Officer over eight years ago, the literature reflects that the diagnosis and management of CFS still today cause controversy and apprehension within the medical profession, especially within primary care. This summary aims to highlight key characteristics, maintaining factors, nature and impact, possible disease mechanisms and management techniques to aid medical professionals to diagnose and treat patients more effectively.

admin@ipcauk.org (IPCA Admin) Volume 3 Issue 2 - 2008 Fri, 02 Mar 2012 13:00:52 +0000