IPCA Admin http://ipcauk.org Mon, 17 Dec 2018 05:21:31 +0000 Joomla! - Open Source Content Management en-gb Editorial http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n2/item/164-editorial http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n2/item/164-editorial

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.

We must now work together to ensure that we engage in a constructive manner, in implementation, for the benefit of our patients. Carping about privatisation, closures, defects in training…….are no longer options. In a democracy we have to accept this legislation, the alternative being anarchy.

The Bill really does put primary care and GPs, in the form of Clinical Commissioning Groups, at the heart of the NHS. In the short time leading to the enactment of the bill and subsequently, my personal experience is that our colleagues in primary care will and are the key decision makers and with it the whole integration and communication process between primary and secondary care will improve immeasurably.

The role of the private sector will undoubtedly increase but there is a whiff of unfairness in the processes that the DH has agreed for tendering. Small and medium sized businesses and social enterprise organisations will have a tough job navigating the tendering and contracting processes, an activity which the big boys can manage with consummate ease. The DH needs to relook at this urgently before the whole process falls into disrepute and/or is challenged legally.
I am delighted to see the Wilkie and Chalmers paper on “Acute cough in adults”. This is a major presenting symptom in primary care and if not assessed appropriately will consume huge quantities of resource. This article simplifies the complex and streamlines the decision making process for such patients.

It is salutary to learn that childhood and adolescent eating disorders frequently continue into adulthood. They really can become Long Term Conditions. Dr Rao provides an insight into a psychiatric area which is the staple diet of the health sections of many newspaper dailies, peddling unnecessary mystique and myth. He deftly enables the condition to be understood and provides suggestions on its management.

Did you know that Cow Milk Protein Allergy is the commonest cause of death from anaphylaxis in children? Read Ware, Apps and Michie’s article to learn how this allergy may present with a confusing kaleidoscope of symptoms across multiple organ systems.

Individual Clinical Commissioning Groups (CCGs), perhaps with mergers, will now comprise tens of thousands of patients. Simon Page, writing on thyroid disease, highlights that for every 10000 size list there will be ~200 patients requiring thyroxine for hypothyroidism, ~100 who will have subclinical hypothyroidism and ~60 will suffer hyperthyroidism. It’s worth getting to grips with this paper for an overview of thyroid disease as you will encounter patients with such pathology.

Tucker, Knox-Cartwright and Ursell address the burgeoning incidence of Age-related Macular Degeneration (AMD). The consequences of a low birth rate and increasing longevity have resulted in an ageing population. The public and doctors will become increasingly confronted with this disease. It is vital that sufferers are picked up early in primary care so that a rapid diagnosis and use of appropriate therapy can save the vision.

In the UK clinical depression is managed mostly in primary care. However, a large proportion of depression is linked to the presence of a Long Term Condition. Alan Cohen’s article provides the startling statistic that in a list size of 10000, 2500 will have a long term condition of which 500 will have associated depression. This latter group consume extraordinarily huge amounts of resource in which addressing the management of depression will lead to clinical gains and in a time of austerity a contribution towards the £20 billion savings over the next 5 years!

Please let me have your thoughts on future areas you would like covered. I would also value correspondence on any of the editorial content by emailing me at the Rila address.


admin@ipcauk.org (IPCA Admin) Volume 6 Issue 2 - 2012 Thu, 12 Jul 2012 07:05:10 +0000
Reflection on a career in Urology and thoughts on the future of service provision http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/163-reflection-on-a-career-in-urology-and-thoughts-on-the-future-of-service-provision http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/163-reflection-on-a-career-in-urology-and-thoughts-on-the-future-of-service-provision


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!

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Fri, 09 Mar 2012 13:07:38 +0000
Syncope and Seizures in Children http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/162-syncope-and-seizures-in-children http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/162-syncope-and-seizures-in-children


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.

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Fri, 09 Mar 2012 13:05:41 +0000
Genital Ulceration http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/161-genital-ulceration http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/161-genital-ulceration


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.

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Fri, 09 Mar 2012 13:03:41 +0000
Diabetes and Pregnancy http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/160-diabetes-and-pregnancy http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/160-diabetes-and-pregnancy


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.

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Fri, 09 Mar 2012 13:02:31 +0000
Contraception in Young People http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/159-contraception-in-young-people http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/159-contraception-in-young-people


Friendly, non-judgmental ‘one-stop’ services enable young people to access sexual and reproductive healthcare. Contraceptive advice should be comprehensive, addressing the young person’s needs and priorities with appropriate follow-up. Evaluating competence to consent and discussing confidentiality are core aspects of the adolescent sexual health consultation, in addition to identifying any safeguarding concerns.

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Fri, 09 Mar 2012 13:01:12 +0000
Lactose Intolerance in Primary Care http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/158-lactose-intolerance-in-primary-care http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/158-lactose-intolerance-in-primary-care


Many people, especially non-Causcasians, have difficulty breaking down lactose (the sugar in milk) after early childhood. It results in gastrointestinal symptoms such as bloating, abdominal pain and diarrhoea following ingestion of milk and milk products, known as lactose intolerance. Lactose intolerance is easily managed by simple dietary modification.

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Fri, 09 Mar 2012 12:56:43 +0000
Editorial http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/154-editorial http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n1/item/154-editorial

The festive season would be over by the time this issue reaches you. We certainly need glad tidings. There are national and international calamities disrupting our economic and health related wellbeing. The Greek economic crisis may well have enveloped Italy and other Eurozone countries with the detrimental effect on the EU economy. As about 40% of UK exports are to Europe this will undoubtedly have a major negative impact on our GDP and therefore on public services. The austerity measures introduced by the government have prevented a financial UK meltdown but at what cost? The NHS will lose £20 billion over 5 years and all other public key sectors are similarly affected, education, welfare, police, councils. However, let us not forget the less obvious targets for reductions in support, such as children’s services, domestic violence….

These are the consequences of our financial profligacy over a decade and a half. As far as the NHS is concerned mismanagement, by successive governments, has resulted in a moribund work force, demoralised and directionless. The spectres of the likes of Staffordshire Hospital, neglect of the elderly, the use of sticking plaster HCAs to shore up services is the end result of a malaise. This affliction is seen in frontline staff that has little or no say in how care is delivered.

All sensible voices advocate more power and decision making responsibility to frontline staff but every reform tends to make this an even more remote possibility. That is why I found the decision to allow Circle Health, a private organisation, to take over the running of Hinchingbrooke Hospital a little odd. That was until I heard the company’s CEO indicate that he intends to run the hospital within budget, meet all target requirements etcetcetc, by placing power into the hands of frontline staff! It would seem that our masters hear only the voices and accept the promises of the third parties and not their own staff. It remains to be seen whether two organisations with completely different cultures can be merged and succeed. NHS altruism and private profit do not make good marriage partners.

The here and now is that healthcare professionals are generally dedicated to their work and despite extremely trying circumstances deliver excellent care. If no one congratulates us then maybe this is a time of year to provide oneself with self-adulation and internal approbation. Whatever the politicians, economists, health analysts and financiers say, the patient, for frontline staff, remains at the centre of our work. I think the one thing that the GMC may have got right is the very first line of its Good Medical Practice: “Make the care of your patient your first concern”. If the motive behind this one sentiment could be executed by all healthcare professionals and dare I say it, also non-clinical staff, the NHS would be a far better place, ethically, clinically and financially.

Professor Ram Dhillon

admin@ipcauk.org (IPCA Admin) Volume 6 Issue 1 - 2012 Wed, 07 Mar 2012 04:20:54 +0000
GPwSI in Cardiology: A Personal View http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-1-n1/item/151-gpwsi-in-cardiology-a-personal-view http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-1-n1/item/151-gpwsi-in-cardiology-a-personal-view


I have had an interest in cardiology for some time, which developed during my time in anaesthesia and I felt that primary care had more to offer in this area. Some brief research (and a few emails) encouraged me to further develop my interest when I heard what others were doing in primary care. I was particularly interested in developing a local echocardiography service due to my personal interest in ultrasound and the pressures on our secondary care provider. A quick audit revealed a turn around time of almost four months from our local open access echo service (from dictation of referral to the typed report landing on my desk). The final catalyst was my desire to work as a GP with a special interest as the daily grind of full time partnership was adversely affecting my quality of life.

admin@ipcauk.org (IPCA Admin) Volume 1 Issue 1 - 2005 Tue, 06 Mar 2012 06:51:07 +0000
Acute Medicine – a brief history http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-1-n1/item/150-acute-medicine-a-brief-history http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-1-n1/item/150-acute-medicine-a-brief-history


Hospital medicine has undergone considerable changes over the past decade. One of these changes has been the appearance of the term ‘acute medicine’ in the vocabulary of clinicians and managers working within the NHS. Since its first mention in a Royal College of Physicians document in 1996, the development of acute medicine has been a ‘roller-coaster’ ride, culminating in the establishment of subspecialty status in July 2003. The field now has its own journal, a specialist society and over 150 consultants across the UK. So what have been the catalysts for these rapid and dramatic changes, and what opportunities does the field of acute medicine offer for general practitioners with special interests?

admin@ipcauk.org (IPCA Admin) Volume 1 Issue 1 - 2005 Tue, 06 Mar 2012 06:49:38 +0000