Volume 5 Issue 2 - 2011 http://www.ipcauk.org Wed, 20 Jun 2018 18:48:31 +0000 Joomla! - Open Source Content Management en-gb Editorial http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/43-editorial http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/43-editorial

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

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:44:56 +0000
Is it temporal arteritis? A review of the condition and common differential diagnoses http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/23-is-it-temporal-arteritis-a-review-of-the-condition-and-common-differential-diagnoses http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/23-is-it-temporal-arteritis-a-review-of-the-condition-and-common-differential-diagnoses


Temporal arteritis (TA) also known as giant cell arteritis (GCA) is the most commonly occurring chronic vasculitis, typically affecting individuals older than 50 years. GCA typically manifests as new onset headache with features of systemic illness although presentation is highly variable. Because many conditions can mimic GCA, accurate diagnosis is essential to avoid over-treatment.

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Tue, 28 Feb 2012 10:26:25 +0000
Polycystic Ovarian Syndrome: What you need to know and do as a GP http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/37-polycystic-ovarian-syndrome-what-you-need-to-know-and-do-as-a-gp http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/37-polycystic-ovarian-syndrome-what-you-need-to-know-and-do-as-a-gp


Polycystic Ovarian Syndrome (PCOS) is a common disorder with clinical manifestations of anovulatory infertility and hyperandrogenism with oligomenorrhea/amenorrhoea, hirsuitism and acne. There is a higher prevalence of obesity, impaired glucose tolerance, type2 diabetes, hyperinsulinaemia and adverse cardiovascular profile in these patients. The complicated interplay between genetic factors, abdominal obesity and insulin resistance play a key role in pathophysiology. Management should be tailored to individual needs. The understanding of the principles of management of long term implications aids to offer holistic approach to this disorder. Many different therapies may be offered to regulate menstrual cycle, induce ovulation and improve signs of hyperandrogenism. Lifestyle improvement and weight reduction are the most important predictors of long term health.

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:14:47 +0000
Clinical Focus Prmiary care:Skin Cancer http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/38-clinical-focus-prmiary-care-skin-cancer http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/38-clinical-focus-prmiary-care-skin-cancer


Skin cancer is the most common cancer in the United Kingdom and incidence rates are increasing. This article explains the common presentation, clinical features, referral guidelines, management and prognosis of both non-melanoma skin cancer (basal cell carcinoma and squamous cell carcinoma) and melanoma.

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:20:39 +0000
Insulin Management in Type 2 Diabetes http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/39-insulin-management-in-type-2-diabetes http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/39-insulin-management-in-type-2-diabetes


This article discusses key issues which underpin the theoretical and practical aspects of initiation and maintenance of insulin therapy in patients with Type 2 Diabetes (T2D). It is a complex area with many different insulin preparations, injection devices and regimens. The intention is to provide guidance to help Primary Care teams better understand some of the issues around insulin management in T2D.

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:24:52 +0000
Plantar Heel Pain http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/40-plantar-heel-pain http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/40-plantar-heel-pain


Plantar Heel pain is one of the most commonly encountered problems of foot pain in active adults over the age of 40. One in ten people will experience heel pain, and for many the problem will have a significant impact upon their daily activities. This article focuses on the differential diagnosis, investigations and management of plantar heel pain in primary care. An evidenced based approach is presented for the treatment of plantar fasciitis, especially considering the multitude of treatment modalities available.

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:32:25 +0000
Dizziness, Vertigo and Imbalance http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/41-dizziness-vertigo-and-imbalance http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/41-dizziness-vertigo-and-imbalance


Whilst dizziness, vertigo and imbalance may be due to systemic disease, they commonly originate from the vestibular system. The presence of vertigo, in particular, implies vestibular involvement. This article will address the diagnosis and management of vestibular dysfunction in adults, highlighting the three commonest causes which can be diagnosed and treated in a primary care setting, and stressing the “red flags” that should trigger referral to more specialist services.

admin@ipcauk.org (IPCA Admin) Volume 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:38:24 +0000
Reflection on a career in Urology and thoughts on the future of service provision – a personal view http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/42-reflection-on-a-career-in-urology-and-thoughts-on-the-future-of-service-provision-a-personal-view http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-5-n2/item/42-reflection-on-a-career-in-urology-and-thoughts-on-the-future-of-service-provision-a-personal-view


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 5 Issue 2 - 2011 Wed, 29 Feb 2012 11:41:27 +0000