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International Primary Care Association

Clinical Focus Volume 5 N2


The planned NHS reforms have kept our medical leaders and politicians very busy over the last few months. The focus has been on the process of commissioning and who should have control of the financial levers, the problem of the private sector cherry picking the lucrative elements and conflict of interest of GPs. The previous structure of PCTs was mired in stagnation, planning blight with an emphasis on managing the finances and not the delivery of care. Any reform that allows us to put clinicians at the front end of the decision making process will be better than what we have had in the past, even if there are warts on the new framework. The public still trust doctors more than most other professional groups, including politicians!

The amount of airwaves and TV time together with acreage of print dedicated to the reforms gives an impression that clinicians are obsessing with the intricacies of the planned changes. Having spoken to numerous colleagues most are getting on with their patient caring responsibilities. Those GPs with a bent for finance and management have self-selected to engage with the implementation of the reforms and many of them, despite some reservations, see them as a move in the right direction. My own take is that it is the monitoring and scrutiny of the process, the clinical and non-clinical components, that needs to be robust so that risks are minimised. More recently, it is reported that the government and Mr Lansley maybe backtracking on aspects of the reforms. I have my doubts. This policy was agreed by Mr Lansley and his deputy, a liberal democrat minister, so the coalition parties are at one. Some lip service of a “pause” in the process will be offered but that will be a smokescreen.

This issue, happily, contains no articles on the NHS reforms but an array ofclinical disorders relevant to daily primary care practice. Mark and Young-Min havepenned an excellent overview of Temporal Arteritis, an infrequent but not to be missed cause of headache. The protean presentation of Polycystic Ovarian Syndrome is discussed by Kalkat and Irani and the role of the GP highlighted. It is opportune to have Worsnop and Craythorne address the issue of Skin Cancer.Many of you will be performing minor skin surgery and so will be required to comply with the Specialty frameworks for “Dermatology & Skin Surgery” just published by the DH. This article will assist in addressing some of the requirements.

The use of Insulin in managing type 2 diabetes is now an increasing option but in which patient. Dr Page has provided a comprehensive review of what you need to know. Pater West has provided a cogent article on those heart sink patients with“Dizziness and Imbalance”. Ali and Baghla address the issue of Plantar Heel Pain,a very common presenting ailment in the community. Finally, Professor Brian Ellis,a recently retired Consultant Urologist, gives his thoughts on how to best structure a local urology service, with a major role for primary care physicians.

All contributors have spent considerable effort in devising the “Assessments”,which provide the reader with evidence of “Verifiable CPD”, which can be included in their Personal Portfolio and used in appraisal. The assessments have to be completed online. Successful completion allows a “Certificate” to be downloaded.

I would also be delighted to receive letters and comments and suggestions on future editorial content.

Happy reading and a Happy Easter.

Professor Ram Dhillon

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